HomeMy WebLinkAboutPlumbing Permit 03-1327
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
1. Blue File I PERMIT NO.(} :3'- !~?
2. Gold City
3. Yellow Applicant
ZONING (office use)
PLLO
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT.:1ctLOCK (ADDITION ~ W
2)rd
PID~S. 331-
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OWNER r-:
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(Phone)
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(Address)
(Address)
APPLICANT
(Name)
(Address)
(City)
(Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
DATE
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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 Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (] or 2 compartment sink Sewage Ejector
Shower Stall Y 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 $
Building Permit #
69- SO
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PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
(Office Use Only)
Date
This Application Becomes Your Building Permit When Approved
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
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