HomeMy WebLinkAboutPlumbing Permit #07-0347
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Date Rec'd
CITY OF ~RIOR LAKE PLUMBING PERMIT 5.. / "', 0 7
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). Yellow Applicant
I PERMIT NO. 0'1 034-71
ZONING (office use)
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S/11101 Pen-VI //~I '-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I OWNER
(Name)
(Address)
(Phone)
APPLICANT - /7
(Name) t;JUS c:::Lr7 .,.:J CZ/) do t/ 4!.--t:.--'
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(Contact Person) v.~ . ~ t/ ~
(Phone)
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(Zip Code) ,
(Address)
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 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 v' Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial. Commercial & Multi-family I % 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 $
39.5V
50
4-0.00
(Office lise Only)
Building Official
Date
Paid 40. u ()
Date _ /_
..5./tP. (/
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4 45
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714