HomeMy WebLinkAboutPlumbing Permit #06-1078
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
IL. (g, 0 ~
I. Blue File I PERMIT NO
2. Gold City . U . I 0 '711.
3 Yellow Applicant V
ADDRESS ZONING (office use)
\
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
(Address)
(PhOne)(Cf5d). Ltt7- JSb'7
c::
OWNER \ _ \ 1
(N ame) '\....x. X1 Xl ]V\ 0 n ~ "')
APPLIC~ .
(Name) Dt PPWO{ ~S
(Address) 3~ ~ .
(Address)
APPLICANT SIGNATURE
O~
(Phone) \en (. 3~ 5.- \31 0
~ MN 5'11~~
(City) (Zip Code)
(Phone) ~Cj, - ~~I ~~b
DATE ,-
(Contact Person) Wi <;
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-So
.50
LfD.dO
(Office Use Only)
Building Official
Date
Paid +D-
Date 12- 7 / ~ &
This Application Becomes Your Building Permit When Approved
NO'5 Z" 92-
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
CAD