HomeMy WebLinkAboutWater Heater Permit #07-0805
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~.l"L ~7
I. Blue File
2. Gold City
3 Yellow Applicant
I PERMIT NO. 07. 00 o5f
I
ZONIN G (office use)
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ed
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID z.~. 011. 61? ,0
OWNER
(Name)
Te-d
8
VeJd \1w 5
(Address)
Q(
u\;
(Phone) <jC)'J ~Lj Llj- :J-4Cj Q
\ G~
APPLICANT
(Name)
Champion
651-385-1340
3870 Dodd Rd. '100
E8gan, UN ~12]'-133e
(Address)
(Phone)
(Address)
(City)
(Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
DATE
t-
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher I Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
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
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
Building Official
Date
Paid 4-0 -
Date :J,{ 40 1
:;.5i/O'f
l
This Application Becomes Your Building Permit When Approved
eipt No. rJ 4S
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714