HomeMy WebLinkAboutPlumbing 07-0595
Date Rec'd
~. ~~ ~~IKanI I PERMIT NO. 07. o59.st
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ZONING (offICe use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
Pro 2..5 . 34<l. ook .0
(Address)
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(Phone)
OWNER
(Name)
APPLICANll ~ / /
(Name) ~ l '12 / Ii 6/ .j
(Address) /C;2Iiu'
(Contact Person) --.SL
(Phone)
APPLICANT SIGNATURE
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
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Estimated Cost $ J,
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
~,
.50
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(Office Usc Only)
This Application Becomes Your Building Permit When Approved
Date
Paid A ..,
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Date /'} :J -
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P. No. 54' 7<J
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