HomeMy WebLinkAboutPlumbing Permit #05-0445
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CITV OF PRIOR LAKE PLUMBING PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 01-06
Date Rec'd
5"'. Ie. oS-
File
City
w Applicant
I PERMIT NO. 0 5". 0#61
ZONING (office use)
/Y'14lfl
LEGAL DESCRIPTION (office use only)
~~e~R Scott ~MenS
(Address) sa me 'f0l D UL ~&
PID 2SJ~. 009. 0
(Phone) LJ 12 20 I 0'2 ~ q
LOT BLOCK
ADDITION
tJ &5'53'12-
APPLICANT
(Name)
(Contact Person)
H.P. PIPEWORKS
3670 DODD ROAD
EAG~N~MJ 5,5123
(651) ~~)13L' ('
f1PJJ5 O.
(Phone)
(Address)
~PPLICANT SIGNATURE
(City) (Zip Code)
(Phone) 51 m ~
DATE 5'-14 -05
APPLICANT PLEASE COMPLETE BELOW
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 Sewage Ejector
Shower Stall REQUEST FOR FINAL Backflow Assembly
Sinks INSPECTION SENT TO Backflow Assembly Test
Bar Sink HO Lawn Sprinkler
Water Closet (Toil MEOWNER 10-06 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
$ ,~ll.SO
$ .50
$30-00
(Office Use Only)
Date
Paid 4fJ.OO
Date 5, 11,' S'
Receipt NO'49 30.5"
By
This Application Becomes Your Building Permit When Approved
(
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
~.(j) HD