HomeMy WebLinkAboutPlumbing Permit #07-0410
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
S/1-~/07
I Blue File I PERMIT NO I
2 Gold City . 0 .., - A ufo
3 Yellow Applicant , f- u-,
ZONING (office use)
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(,lL
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)~Qlt
(Address)
LtIL. Sw
(Phone) It,(~-dl'~-/Sld
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~te.~
APPLICANT
(N ame)
(Address)
~~
~
(Phone)
(Address)
(City)
(Zip Code)
APPLICANT SIGNATURE
(Phone)
(Contact Person)
DATE
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 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 X 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 $
TOTAL PERMIT FEE $
34), ~O
.50
'id/OO
(Office Use Only)
S;-/2~/07
.
Date
This Application Becomes Your Building Permit When Approved
~~
Building Official
Paid
Receipt NO.S3g.'IS
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714