HomeMy WebLinkAboutWater Heater Permit #07-0644
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File I PERMIT NO ~
2. Gold City . /."1. 0(0
3 Yellow Applicant (.J ~
ZONING (office use)
/'I//L
4/E
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID Z (. ( '( r () 6 ~ ()
OWNER
(Name)
,1((.1'1/ %~~
(Phone) &'>2) I/t/S-- ,Sy/$
(Address)
APPLICANT / / / AI j.
(Name) M/b/,,,, 1711I///7
(Address) 29o~ ~U Ji&.t S
(Address)
(Phone)
t!f8
(City)
(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 $ (00
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
1tf. ~ 0
.50
lIo .00
(Office lJse Only)
This Application Becomes Your Building Permit When Approved
Date
Paid .tI A. ,'j"
'T r.,'. &(.1
Date '7 ':0" t'-7
. '-' --\ ,-
o. ,5tf 24-"
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 U
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714