HomeMy WebLinkAboutPlg Permit 01-0645
Date Rec'
1. Blue File
2. Gold City
3. Y cllow Applicant
ZONING (office use)
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or print and sign at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
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(Phone) ~S~ -LlL(,~ 1?JIQ
(Address)
APPLICANT .~ J m"\J1l rV'"'
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(Address)
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(Contact Person)
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(City) (Zip Code)
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(Phone)
APPLICANT SIGNATURE
DATE
Quantity
APPLICANT PLEASE 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 Stall
Sinks
Bar Sink
Water Closet (Toilet)
Type of Fixture
Rough-ins
Water Heater
Water Softner
. 1:'+".....-1 Pinp. (Washing Machine)
REQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
. RESPONSE - CLOSE FILE
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
(Office Use OnIY~ I ~
This Appli( ,
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit # C ( - 0 (, ~
.3 "1, r7)
$
$
$
.50
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Date l, ~ U r() I
-
Rec:i1l
B1/Y1
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Estimated Cost $
omes Your Building Permit When Approved
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Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245