HomeMy WebLinkAboutPlumbing Permit #13-107 � � ��
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� CITY QF PRIOR LAKE PLUMBING PERMIT
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2. c�w a-� PERMIT NO. ��. ` 7
3. Yepow Appitant �„
lease or nt and si n at bottom
ADDRESS ZOI�'ING (ott7ce use)
���� hPRS'c�rh ) 2cfi ��az/ �� ��
LEGAL DESCRIPTION (o�ce use oniy) '
LOT BLOCK ADDITION � pID
OWNER
(Name) ��u �rh l�� � �' �2�'t h K-e �/ .{Phone) 9S - 22� - 5�lCI" )
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(Adcirress) � (� � � j - G-�t/ S� L✓ rrc kc w�
APPLICAI�IT
(Name)_ �"c v i�c,� T�.,�" (Phone} _ 3 2 v-ZS I 2 .5 - u �
(Address) 32_ c: � .'�-, f �f t. �. � .S�' (d v �► iNa.(� �� �' k /Ll n �i � 3 k ?
{Address) tCit3►) CLiP Code)
(Contact Person) �Cr't.,�c� � (pkone) 3 L(� - 2.S 1— 2.�`i S
APPLICANT SIGI�FATURE � . �. DATE .
APPLICANT PLEASE COMPLETE BELOW
uanK e of F`igture anti e of I�`iature
Batk Tub witi� or withaut shower Rou h-ins
Dishwasher Water Heater
� Flaor Drain � Water Softener
.Lavata athroom Sink Stand Pi e ashi 1Vlachine
' Laund Tra 1 or 2 com ariment sink Sewa e E'ector
Sho�ver Stall Backflow Assembl
S� Backflow Assembl Test
Bar Sink - ��y� � ��
Water Claset Toilet Other
FEE SCHEDULE
Industrisl, Commercial8c Multi-famiiy 1°� of jab cast with a�49.50 miaimum Residential, N�w One 8c TwaFsmily �1�{9.50
ResidenGsE, Additions 8c Aiterations $49.50
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Estimated Cost $ �� U Building Permit #
PLUMBINC� PERMIT FEE $ � q , ��
STATE SURCHA.RGB $ 3,8p
TOTAL PERMTP FEE $ �� • ✓ 'C
(ontc� crse o�uy}
Thfs Applfcatian Becomes Your Buiidiag Permit When Approved Paid�.i /� Receipt No. A'� p�
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BnRdins Offidal �� Date � J .� By /�'�
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24 bour nottce for ali intpecdona (952) 447-985Q, fax {952} 447-4Z4S .
4646 Dakota Street 3.E., Prior Lake, Mianeaota 55372
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