HomeMy WebLinkAboutPlg Permit 01-1242
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
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I ADDRESS
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I. Blue File PERMIT NO
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3. Yellow Applicant ~
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ZONING (office use)
LEGAL DESCRlt' lION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
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(Phone) ]@? ,-pJ Y6~ O/Ys-.
(Address)
APPLICANT
(Name)
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(Phone)
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(Address)
(Contact Person) (r;:~ 1!1MrL-
APPLICANT SIGNATURE ~--_ ......
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APP~~SE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower StaB
Sinks
Bar Sink
Water Closet (Toilet)
(City)
(Zip Code)
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DATE J/-/,~tJ/
(Phone)
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
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REQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 4t; ~ (JiJ
Date {/_ /... () I
Rec:1V7 r3
By .~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245