HomeMy WebLinkAboutPlumbing Permit #07-0322
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
; ~~~ ~~~ I PERMIT NO. O~ . 0'2 '7 ~ I
3. Yello\\ Applicant -'- J,-g-
ZONING (office
use)
44"32.. C'oICJrQ&o 5+ S E
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
OWNER DCDr\ W'\l~oh S
(Name)
(Address) 443 2- Co I CJ('o..d.o St- SE
PID
(Phone) 152-440- 7'142-
r Prlo (- Le>.-kt. fY1 N S- S- 37 2.
APPLICANT J "h, " ~ 0 ({) 0 (0 0
(Name) A- d..m S N- ~'f +\ m--e Plu VYlJo \J. (Phone) 12- - ~ S---
(Address) l31c{ lJ'oV\ ~\J \ \ L-~€.. ~. I 0 G..-\{M'I\ M N ,~S 3 2- 7
(Address) J (City) (Zip Code)
DeCUt\ \< Q~'<l f' w-'\--+\ (Phone) G 12..- LO -S' - 0 a ~ d
(Contact Person)
DATE
APPLICANT PLEASE COMPLETE BELOW
,~~
b/4/t
APPLICANT SIGNATURE
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 Eiector
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 $ (Q 0 0 Building Permit #
PLUMBING PERMIT FEE $ ~ ~ .,SO
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 4 CJ , 0 0
(Office lJse Only)
Buildin!! Official
Date
Paid .f(), 0 0
Date 5 /0 () 7
Receipt No. 5 3' 43 ~
By
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714