HomeMy WebLinkAboutPlumbing Permit 09. 0519 N .
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CITY 4F PRIOR LAKE PLUMBING PERMIT JUL 14 2009
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By
��I NN SSO� A E. H3ue File i�l�p
2, cold city PERMIT NO.Qq 0 : 5' 1
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
U i "4 - I 4cu(bpy-
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. _
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OwNEIZ - '666 V t 5 n �� l . ( Phone)
(Name) _
(Address) 1 1 .... Lh 9/ . ' I t/ J U ./
APPLICANT - r � t .
'' Mru 55351? LPL 1 A 1 O' / ' •r e) I �
(Name) � • /
(Address) i..._� 7 p tippe / ! /05 w
(Address) / (City) • (Zip Code)
......._ (Phon) -50 ' 5 g
(Contact Person) 4 / _ ..� Z
APPLICANT SIGNATURE _ _ — ' —2 /
APPLICANT PLEASE COMPLE' .: BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) _
Laundry Tray (1 or 2 compartment sink _ Sewage Ejector
Shower Stall Backflow Assembly
Sinks 1
Backflow Assembly Test_
Bar Sink Lawn Sprinkler
1 Water Closet (Toilet) I Other -
EE SCHEDUI$
Industrial, Commercial & Multi- family 1% of job cost ith a $49.50 minimum Residential, New One & Two - Family $149.50
• esidential, Additions & Alterations $49.50
Estimated Cost $ PIS Building Permit #
PLUMBING PERMIT FEE $ '9,��
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $
(Office Use only)
This Application Becomes Your Building Permit When Approved Paid W Rec • i r No. Z , r G ~� 1
Dal
Buftdins Official Date . "/„I_W iff. 1
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.R., Prior Lake, Minnesota 55372