HomeMy WebLinkAboutPlumbing 03-0819
CITY OF PRI~KE PLUMBING PERMIT
t/ 1
CJV0> 4-' ,6)
tb. \
Date Rec'd
(; ,Z- 0 . 03
(Please type or print and sign at bottom)
ADDRESS
I Blue File
2. Gold City
3, Yellow Applicant
I PERMIT NO'03 -08/q j
1-- L-f 'lJ 1
Stone crest-
PCLih
ZONING (office use) I
LEGAL DESCRIPTION (office use only)
LOT 5 BLOCK I ADDITION
nt;./12ZJwV( 6J
PIDZS-3/#-- 605-0
OWNER
(Name)
D1Ul ( Sm,/1:-n
m?)l <..StDnerr-i:s-t PaH?,
NOYhlom PUunhLnCl (Phone)
2-qn,~ HtUfJeLd JYVe.-~ 60. J
(City)
(Phone) (qfjZ rn4 -~{j-fO
(Address)
APPLICANT
(Name)
(Contact Person)
AmLj
'PLICANT SIGNATURE 7Af'1/"l'--' DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity I Type of Fixture I Quantity I
I Bath Tub with or without shower I Rough-ins
I Dishwasher I I Water Heater
Floor Drain I Water Softner
I Lavatory (Baiom Sink) I I Stand Pipe (Washing Machine)
I Laundry Tray r 2 compartment Sink~ _ I Sewage Ejector
Shower Stal . II) I Backtlow Assembly
I Sink~ ' '-' I Backtlow Assembly Test
I Bar Si I I Lawn Sprinkler
I Wat se let) ~ I I Other
IndustrAm\f& 1JJKI%fwlthaF~~5~?n~~~LE ~ ~~~;ff!::~toY
V ~. Resldenltal, Additions & Alterations $39.50
_... lES ' d st $ Building Permit # 0'3 -0 8/1
.-. PLUMBING PERMIT FEE $
STATE SURCHARGE $ ,50
TOTAL PERMIT FEE $ LfD DE
(Phone)
[WI1-) ~f 7--Lfo?JD
m 015. fhLfOg
, (Zip Code)
((p 17--) ~/.-7 - LfOo3
l..R I If) / 00
(Address)
(Address)
Type of Fixture
ice Use Only)
!tis Application Becomes Your Building Permit When Approved
Building Official
Date
paid4-0,OO
Da2, . 2-0. (j]
I Receipt ''Pf.1.fpfR 5
IBcf.
I
I
/
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714