HomeMy WebLinkAboutPlg Permit 02-1331
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2 Gold City
3. Yel10w Applicant
PERMIT NO.C~~) -- 13 ~)
(Please type or print and sign at bottom)
ADDRESS
LEGAL DESCRIPTION (office use only) ,
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OWNER
(Name)
(Address)
APPLICANT
(Name)
(Address)
(Contact Person)
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ZONING (office use)
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(Phone)
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(City) (Zip Code)
(Phone)
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DATE
APPLICANT SIGNATURE
Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor
Shower Stall
Sinks
Bar Sink
Water Closet (Toile
Type of Fixture
~ "'- ..... ~ ....1,
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
I Backflow Assembly Test
I Lawn Sprinkler
I Other
REQUEST FOR INSPECTION
SENT TO CONTRACTOR NO
RESPONSE - CLOSE FILE
FEE SCHEDULl;
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
(Office Use Only)
Estimated Cost $
Building Permit #
(1 (l S-D
.50
L10. -
l
Paid /1- Receipt No. \)- <.:> ""')
Vf 0 l/.-;:r... 0 0 ,?'\
Date /tj . /o-() ~ _By
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
This Application Becomes Your Building Permit When Approved
Building Official
Date
(;:c----
J
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714