HomeMy WebLinkAboutPLMBG 06-0570
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'" (till> ~ITY OF PRIOR LAKE PLUMBING PERMIT
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Date Rec'd
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I. Blue File I PERMIT NO I
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3 Yellow Applicant , _
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ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I OWNER
(Name)
(Address)
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(Address)
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(Address) -
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(Phone)
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APPLICANT
(Name)
(City)
(Zip Code)
\.PPLlCANT SIGNATURE
(Phone)
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DATE
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(Contact Person)
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 (1 or 2 compartment sink Sewage Ejector
Shower Stall Backtlow Assembly
Sinks Backflow Assembly Test
Bar Sink l Lawn Sprinkler -OV rL",)
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial, Commercial & Multi-family I % 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 $
31- 5V
.50
HJ. t/U
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid 40 _
Date fr.;} 7. ()fc
Receipt No. 51 r'i .f-
By
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714