HomeMy WebLinkAboutPlumbing Permit 09.0594 •
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4 PRIG
4e CITY OF PRIOR LAKE PLUMBING PERMIT Date Rec'd
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I.Blue Fat I PERMIT N 1
2.Gold City —5C^ J
(Please type or print and sign at bottom) 3.Yellow Applicant
ADDRESS
5 0 3 5 f/o,o" . .- ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PR)
OWNER
(Name) isclY 7 110F c• ti SO
h (Phone)
(Address)
APPLICANT ' / ' �,Q
(Name) ,4 6k W i d,( Ply tll..,4
5 pit°• (Phone) 951 a5a — So?97
(Address) 99 Y9 /90 1• Sliver Li S3-38/
(Address) (City) (Zip Code)
(Contact Person) 8 r t ck (Phone) 5.-2) 0-90?- 5e29 7
APPLICANT SIGNATURE 13.4.— i-il-ariDATE 7//db 9
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
a. Bath Tub with or without shower Rough-ins
/ Dishwasher Water Heater
Floor Drain Water Softener
2 Lavatory(Bathroom Sink)
Stand Pipe(Washing Machine)
Laundry Tray(1 or 2 compartment sink Sewage Ejector
/ Shower Stall
/ Sinks Backflow Assembly
Backflow Assembly Test
Bar Sink Lawn Sprinkler
a Water Closet(Toilet) Other
FEE SCHEDULE
Industrial,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
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Estimated Cost $ 50UO Building Permit#
PLUMBING PERMIT FEE $ etc(- Co
STATE SURCHARGE $ .50
(Office Used►nly)�--. TOTAL PERMIT FEE $ 50-
This , ,A0, :ecomes Your Bui ding Perm it W,..0he Approved Paid
Receipt No
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..ine Official Date v /'v By tea pt...Date (2�.. 1(LI/,//24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372