HomeMy WebLinkAboutPlumbing Permit #06-0802
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
1 IOMEOWNER
16252 LAKESIDE AVENUE
PRIOR LAKE, MN 55372
:::;~ ~~~ I PERMIT NO. /"'\ J , (}n h
'ellow Applicant, U(fL CJ:.U~
j(Pq 98/ ;:fM UA~NtL/
ZONING (office use)
LEGAL DESCRIPTION (office use only)
OWNER
(Name)
(Address)
LOT
BLOCK
ADDITION
(l.,AJ ~~ (Phone) 76 '3 ~'3/ O'fS~
APPLICANT '^/\ I) ~
(Name)~"-L. ~
(Address) 9-13 m ~ () V '3 ..0"'(:
(Adfuess)
(Contact Person) (<.0 \\Ad V'I\~ C~Y")
(Phone)
7~:3'" 5"5'1- 0 5.5'5'-
~~I
(Zip Code)
tt3 ,~- 98'S ~ tJEPY
o,...()<Q
(Phone)
~~ rt-4tJ
(City)
APPLICANT SIGNATURE
DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
I' Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
I 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 $
3cr So
.5j)
tjO:--
(Office Use Only)
Building Official
Date
This Application Becomes Your Building Permit When Approved Paid
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714