HomeMy WebLinkAboutBuilding Permit 03-0071 (2)
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
1_ Blue File
2. Gold City
3 Yellow Applicant
I-i B-fJ :5
I PERMIT NO.~J' 007/ I
,
(Please
ADDRESS
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
-0
OWNER
(Name)
(Phon~c~ d ."
Lj1/7- 7 '-I3Cj
,
(Address)
APPLICANT
(Name)
(Phone)
(Address)
(Address)
(City)
(Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
DATE
i-I 3C 3
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
APPLICANT PLEASE COMPLETE BELOW
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 # OJ... 0 () 7 J
,3Q,00
t> .50
~.----
$
$
$
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Date
B
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
Building Official
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