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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
3. Il. 01
~.:~ ~::y I PERMIT NO. 01. 0 II II'.' I
3 _ Yellow Applicant , - \t:,
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDL)_O~)8. ob3 .1
I &~e~~\ \ (jOO\0(
(Address) ~
APPLICANT
(Name)
H.P. PIPEVJORKS
367-0 DODD nOAD
EAGAN, MN 55123
(65t) S05 1340
(Address)
(Address)
(Contact Person)
(Phone)
(Phone)
(City)
(Zip Code)
(Phone)
DATE
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 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 ~CZC> ,00
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Building Official
Building Permit #
$ (~9.fS,D
$ .50
$---YO,oo
paid4-0 . on
Date3 ! L ,0-'
Receipt No. - :> 7 /",
0..5 t.-U I
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
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