HomeMy WebLinkAboutPLMBG 07-0648
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c \~ t;y OF PRIOR LAKE PLUMBING PERMIT
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Date Rec'd
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I Blue Flie
2 Gold City
3 Yellow Applicant
I PERMIT NO. 07. O~401
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I OWNER
(Name)
(Address)
(Phone)
APPLICANT^^ .. ("' (
(Name) ~ '( \(.. \ \ ~S 0.... \....A 0':5"'-
(Address) ~<6<lo t.JJ i I \OW~oc& St-.
(Address)
(Contact Person) _lJ"\o.J \ SSo-
APPLICANT SIGNATURE
(Phone) ---.9Sd-- L(Yl-s'i(" (
pr,'or ( 0 r () S s 3 J:)....
(City) (Zip Code)
(Phone)
DATE 7 a'" (ff
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 1/1 Backflow Assembly Test
Bar Sink ,]V 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 # _
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.:i: 9. so
.50
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(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid40.00
Dat~. z4-, (I
Receipt No. 5~ZS-J
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