HomeMy WebLinkAboutPlumbing Permit #07-0527
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3 Yellow Applicant
I PERMIT NO. 07. o52~
ZONING (office use)
'e,
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ZS-. 00 i ~ I z,&,. (;
OWNER
(Name)
(Phone) Cq5~) &'6&" ~lqq
(Address)
APPLICANT
(Name)
(Address)
(Address)
(Contact Person)
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher , Water Heater
Floor Drain I 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 $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
,'J1.SQ
.50
to.o~
(Office lise Only)
This Application Becomes Your Building Permit When Approved
Paid
Building Official
Date
, (,1)
Date t ). t 7
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714