HomeMy WebLinkAboutPLMBG 04-0144
THIS FILE HAS BEEN
CLOSED DUE TO
INACTIVITY 4/18/2008
Date Rec'd
'Y OF PRIOR LAKE PLUMBING PERMIT
l'-/tJ3/
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 01-05
V, r .eU)w~ !tv.fA1/A.-e.. N. E.
-""''''=n"t- ./
~
~~~Iic.nt I PERMIT NO.tYI- /L/tJ(
ZONING (office use)
ISO
LEGAL DESCRIPTION (office use only)
LOT I BLOCK I ADDITION
(Address)
PID dS-
OWNER
(Name)
(Phone) J1g) 14 J - '/'1 tJ tf
. ~.
APPLICANT l. \ \ ""i)
(Name) \\J ~ rb OW\ r hW1I\ b M-{J
(Address) 2' 0 S- (~6H~J d AV<--. ~ I) .
(Address)
(Contact Person) ~ '/
(Phone)
\'A pis
(City)
-ryPLICANT SIGNATURE
(Phone)
DATE
3Jp /4f
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher I Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink --- --- -.--.- Sewage Ejector
Shower Stall Backflow Assembly
Sinks ......-,--.- Backflow Assembly Test
Bar Sink --_. ._. Lawn Sprinkler
Water Closet (Toile -.-..'- Other
-.-,.--
APPLICANT PLEASE COMPLETE BELOW
~'EE ~,--tlEOULE
Industrial, Commercial & Multi-family 1% of job cost with a $39,50 minimum Residential, New One & Two-Family $99,50
Residential, Additions & Alterations $39,50
Estimated Cost $
L{ 0"0 II!!
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
31. S'V
.50
'10. ~o
(Office Use Only)
Date
paid-:!) 1'-'
-J- ,.>-0
Date ~ Lf9,.S""-
Rec"6~~~
Bt:,
~his Application Becomes Your Building Permit When Approved
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714