HomeMy WebLinkAboutPlumbing Permit #07-0074
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
2.(+.07
~. ~~~ ~::y I PERMIT NO. 0"". DD] if I.
3 Yellow Applicant ~ _ ~
ADqj ~~). /.)
5-JOO\ Hill Cr. Sf
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 25 OUr. () 0 Z. .0
OWNER
(N ame)
(Phone) 45'J-4'17" ~I/Lfd-
5s3r'J
(Address)
APPLIC~ ("
(Name)W On~~
(Address) &10 \)yjrLf-d
(Address)
k(i ~ 0\ e ()
(Contact Person)
(Phone)
(Phone) {(n\ - 3(rfj' lliIo
l:: Ctq an I 1Y)t-J.. SCJ I ,~ ~
(City)] (Zip Code)
l'S~
J-::(-
DATE
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 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 $
3<1,50
.50
J../O~DO
(Office lJse Only)
Building Official
Date
~I() .~
This Application Becomes Your Building Permit When Approved
Paid
Rec . t No. 'E2'~Z-
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