HomeMy WebLinkAboutPlumbing Permit #07-0255
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~.:: ~:~y I PERMIT NO. 01. O? S s-+
3 Yellow Applicant , '- :::J
ZONING (office use)
3/1
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
OWNER
(Name)
(Address)
APPLICA
(N ame)
(Address) 3/~
PID'C..\.l4-l. (; Z-3 . ()
(Contact Person)
(Phone) C;SP- ~~/- ci!j8'7 v:;
I
C (Phone) 915~- ex 9cJ. -(Jc5--g'rJ
L:2P('./e /3;P/lJS ;//Lle inN 5/;';31.:3"
(City) (Zip Code)
(Phone) 9-<':9. -,52. q ;)-L) &[5 cJ
APPLICANT SIGNATURE
DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher j Water Heater .-J
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 $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
9Cr ~7
.50
(Office Use Only)
Building Official
Date
Paid 46. (j 0
Date L2... 4 .
,.z., (,'
o. 53 ~J..s-
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