HomeMy WebLinkAboutPlumbing 07-0508
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05/11/2007 20:42
19524405478
APPL INSTALLERS
PAGE 02
l'tV
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
..w1l4l~
~ ~_ SIClftI I PERMIT _~o. 07-0 Su fJ I
I I ZONrnG_~ I
I ~ms-7:~~ rHcIden vtM ~
LEGAL DESCRlPTION (office use only)
LOT BLOCK
ADDmON
Pro 2.( 7/4 { . (j()~ - 0
OWNER
(Name)
(Address)
~tOtf ~~~ ii ~ .
\ L\ lOL{ \+teldtn VlWJ = -~ ~
(Phone) o.~lI. ~. ?eo"
I
(Contact Person)
(phone) --A~?\., ~~'5fsD
~ IfF/JPt1
(City) (Zip Code)
(phone)
APPLICANT SIGNATURE
DATE
(p.
Quantity Type of F1mre QIlantity Type ofFixtare
Bath Tub with Of without shower Rough-ins
\ Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Srnk) Stand Pipe (Washing Machine)
Laundry Tray (t or 2 oomplll1ment sink Sewage Ejector
Shower Stall Backflow Assembly
~ Sinks Backflow Assembly Test
Bar Sink J:.awn Sprinkler
Water Closet (Toilet) l Other lmlin QftO
I
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial. Commercial & Multi"family 1% of job cost with a 539.50 minimum Residaltial. New One &. Two-Family $99.50
Residential. Additions & Alterations $39.:50
Estimated Cost $
Building Pcnnit #
(OMte Ule Only)
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
~" .IJV
.50
'1b ..m
nis Application Becomes Your Building Permit When Approved Paid
Bwilding OOidal
Date
D1itl:
24 bour notIelll for- all i~ti.QS (952) 447~9850, fill!; (952) ....,.....24S
16200 Eagle Creek Ave., S.L, Prior uke, MN 55372-1714
~ l10.(X)