HomeMy WebLinkAboutPlg Permit 01-1178
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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1. Blue File PERMIT NO 1)
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J. Yellow Applicant (r /1 , . r
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ADDRESS
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LEGAL DESCRIPTION (office use only)
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(Address)
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APPLICANT/.? L --.e; / /. (11'_. ~ ~
(Name) !J.-:::r:J 'fJ ~ ~
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(Contact Person) f? Pl--dM~ .;
APPLICANT SIGNATURE R~~~
(Address)
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DATE /{J --- / ;~/
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain I I Water Softner
Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
Laundry Tray (l or 2 compartment sink I Sewage Ejector
Shower Stall I Backflow Assembly
Sinks I Backflow Assembly Test
Bar Sink I T M"_ C__:_I,lo_
. Water Closet (Toilet) CLOSED WITH BUILDING PERMIT
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 $
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Building Permit #
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.50
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Paid df lIO... (2)
Date Ll 01 J
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