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HomeMy WebLinkAboutPlumbing 03-0005 UO/~~/V~ L~~ y~._. ..' -" Date Rec'd Lll'Y OF PRIOR LAKE PLUMBING PEIllVlIT I. DIu" Fl!c \ P'ERMITNO --------" ?!"" '1. Gold C,ty .()~ /)/)/) 1 3. YelloW AppllWlI J ~G/L/ ; (Please type or prlnl ; Ill! $i9;l'll!.t bottOm.) ADDRESS . ~ /1J-V fYla:rc;;hJ;hj LEGAL DESC.: IPTlON (office use only) . , Wf !JflLO( id- ADDIDON Ih~-6-d2cf2 L/l7\ OWNER ~./1 II 4_" (Name) L 1. I:S:-. \ 'f:51()t,,/g) YI_- (Address) XJ~lon ~vlc/qP Ct 'TO'N- IN---- "G .".. i ~ !\:\m~e '\~'::"i ; 12~ ,'i .--I . \ PID -;;< s-- 3 S'b - 03(1- 0 I (phone) q6'>~S- 72-7l- La IF 071 j fl * /(J) APPLICANT Surge Water Conditioning ~ l) (N amt) , m61 Mim ,e\lJ"kll Bi';~. ~hone; - \ . /..1 V~'-, '" (Address) Mifm9\OI1ka, MN 55305 cY( . \ ._ _ (Address) ~:>~-~.:lo-ieSO - (City) ~ D .u;on:actPerrol~ _.~ ~~ (Phone)~Jl~~j')J ..<PLICANT; GNATURlt~ ~ 'j, J. u ~-_.- DATE -_\ ~ / ~p~~;;L~^~ COJn.LETE BELOW . Quantity Type of Fixture Quantity ---- . Bath Tub with or without shower .~ Dishwasher ;' Floor Drain ;\ LavatQry (Bathroom Sink) -- Laundry Tray (1 or 2 compartment sink -'; Sl\ower Stan .Sinks Bar Sink , 'Water Closet (Toilet) (Zip Code) Type ofFis:ture ( I Rough-ins - - Water Heater W Bter Softner Stand Pipe (Washing Machine) Sewage Ejector - . Backflow Assembly Backflow Assembly.Test ~Lawn _Sprinkler Other -- - ~~._._",'.a"'~ FEESLtlf.iDUJ.,E lilG~;))t1il.\l. COlli nen;ial & Multi-family 1 % Qfjob cost with ~ $39.50 minimum Residential, New One &. Two-Family S99.50 Re!lidential. Additions & Alteration$ $39.50 Estimated Cost $ Building Permit # _ Date ,~q~ .50 uQiD . - Pajd (/ () _ uc) Date!_(_{)~ . I Receipt 'No. / 4.--3 r;'J- By (0 . " ~ -' f"c.) PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTALK~~TFEE $ i.-::-:....~.:--:'. :j::: -r'.':it;:). i.-"~;:,~.;.~~'~~;;;~' !U11 BetQrnes -Vour Building Permit When Approved r;1.1!!~'~ g .jf/ldsl 24 \\ol,r notice for all inspections (952) 447-9850, fax (95Z) 447-4245 ~. .----- -.~-_.........-