HomeMy WebLinkAboutWater Heater Permit #07-0730
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File I PERMIT NO.Ol. 073Ll
2. Gold City
3. Yellow Applicant
ADDRESS Ave NE ZONING (office use)
)y ?:> ~
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID 2~. lo5 n(,,(, , U
OWNER
(Name)
(Address)
APPLICANT
(Name) Champion (Phone)
651-365-1340
(Address) 3670 Dodd Rd #100
t:~~lMMN)55123-1339 (City) (Zip Code)
, ~ 0\ e ~
(Contact Person) (Phone)
APPLICANT SIGNATURE '::> DATE
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 1% of job cost with a $39.50 minimum
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ J.Q) ,. (JJ
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
:/1 . 00
.50
t-fO.VQ
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid ~O., c' V
Date 6.. " . G' 7
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;0 j~1
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714