HomeMy WebLinkAboutPlg Permit 02-1411
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
I. Blue File PERMIT NO a~
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J Yellow Applicant
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ZONING (office use)
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LEGAL DESCRIPTION (office use only)
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(Address)
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APPLICANT SIGNATURE
OWNER
(Name)
(Address)
APPLICANT
(Name)
(Address)
(Contact Person)
Quantity
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(Phone)
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(Phone) Cfi2J-LfOfY 0110
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(City) (Zip Code)
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DATE IDtz,~~
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain 'R1E I Water Softner
Lavatory (Bathroom Sink) SE QlJEST F . Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 comp' R.E NT TO Co OR. INSPE ~ Ejector
Shower Stall SPONSE NTR.A.CT CT10N JW Assembly
Sinks - CLOSE FOR., NO ,ow Assembly Test
Bar Sink lLE Sprinkler
Water Closet (Toilet) I r
Estimated Cost $
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
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
Building Permit #
'3 erst)
.50
1/0, .-/
I Paid J//J.. ___ . Rece2l"JeJ 1-"
Date By ,
Date //J- ;)3-d.- r:'/
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official