HomeMy WebLinkAboutPlumbing Permit 10.487 I
OteSed
t PRtp Date Rec'd
4 v.. CITY OF PRIOR LAKE PLUMBING PERMIT
v hi
41 l n`NESb
. Blue F i
oold c, k PERMIT NO. 1 b
(Please type or print and sign at bottom) Yellow nPpr Aux 7
ADDRESS ZONING (office use)
S%'1 l 1L O 5-k .SE 553 `? -
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID `L.3 ,. 6 I ...
(Naame) � f\ r a G,vv, 5 0 �'t (Phone) - �I9
(Address) .51S1 1 ,..S F .5
APPLICANT
(Name) CUL-LIGAN WATER CONDITIONING (Phone)
6030 CULLIGAN WAY
(Address) MINNETONKA. MN. 5fi345
` (Address) (952) 9 33 -7204 (City) (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURE 1 4 - - ► - - 'r, DATB S ° d / D
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 1 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 I% ofjob cost with a $4930 minimum Residential, New One & Two - Family $149,50
Residential, Additions & Alterations $49.50
Estimated Cost $ aZ 6O, 00 Building Pennit #
PLUMBING PERMIT FEE $ 49.
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 5t) , 0 0
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Re " ipt No.,"
.G). f) d Cgs
Date + /O B
nuildine Official Date .
24 boor notice for all inspections (952) 447-9850, fax (952) 447 ^'
4646 Dakota Street S.E., Prior Lake, Minnesota 55372