HomeMy WebLinkAboutPlumbing Permit 12. 1307 (2) • J N'
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CITY OF PRIOR LAKE PLUMBING PERMIT
I riNNESe ;. cola coq a_ :: 7g: I PERMIT NO. ^ /207 I
S. Ydbw Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3S L i VII /\ow :■ _ . 3b, 4 c _
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
((Name lull 1 1 < h ira I i ( Phone) G Leg O &v p
(Address) SCVt N'C/
APPLICANT OharlDlQR MUIYibllig
(Name) rc 000308 (Phone)
(Address) 651- 365 -1340
_(Address) 3670 Dodd Road (City) (Zip Code)
(Contact Person)
X.L1 n E , NIN -65123 (Phone)
1 0 APPLICANT SIGNATURE � Ja i DATE Y ' &S °---
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rou i
Dishwasher ater 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 Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi- family l% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
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Cost $ 7
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $ CC 1 .50
TOTAL PERMIT FEE $ c7 SO
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid g / L J - 0 Receipt No. 7 , 7
Date Building Official Da Dateg //1�� By � f ` 5
24 hour notice for all inspections (952) 447 -9850, fax (9522)447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372