HomeMy WebLinkAboutPlumbing 07-1175
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File I PERMIT NO I
2. Gold City . 6 7, I f 7 1--
] Yellow Applicant .
ZONING (office use)
Sf 5531
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID Z5. (J 11. /I k .0
OWNER
(Name)
~wo..r&
b
C~O'-1
\-\ ' , \ \ c vt.,S -\
(Phone) bl do - 36b- ~ 3lf )"
(Address)
5\
SL
APPLICANT
(Name)
(Address)
CULLIGAN WATER CONDITIONING
f:5UJO CULLIGAN WAY
MINNETONK,A., MN 55345
(A.95;e~s~33. 7200
(Phone)
(City)
(Zip Code)
(Contact Person)
(Phone)
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
Floor Drain I 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 $ den. Dr')
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
39,50
.50
Lfo, Db
(Office Use Only)
24 bour n~
16200
Paid 4-6. oU
Date , z..-...I c" \i -7
City of Prior Lake Bldg. Dept.
4646 Dakota Street Southeast
Prior Lake, Minnesota 55372
Phone: 952.447.9850
FAX: 952.447.4245
This Application Becomes Your Building Permit When Approved
N~50bD
Building Official
17-4245
14