HomeMy WebLinkAboutPlumbing Permit 03-0720
/
CITY OF PRIOR LAKE PLUMBING PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
tPlease type or print and sign at bottom) HOMEOWNER 8/19/03
ADDRESS
/ f.pfp 7:3 AnIYl 7i-~1
Date Rec'd
~: ~:~y I PERMIT NO.I)?_ -?"LG)
ellow Applicant f'/ ;-)' ~ CT'
LEGAL DESCRIPTION (office use only) /J, . ....1
LOT J L, BLOCK (ADDITION t If) ~ 0- ~/vU
, OWNER" I A, M ~ J ",L; .....
(Name) ~rnl P'/Y7L/1 t (Phone)
(Address) . (S~ .a~ aj;;r;ve)
APPLICANT CULLIGAN WATcH vuNDIT10NING
(Name) 6.030 CULLIGAN WAY _ (Phone)
MINNETONKA. MN oS--,,4~
(Address) ~) 933.720()
(Address)
(Contact Person)
~~~
APPLICANT SIGNATURE
~
DATE
ZONING (office use)
12/
PID~5-0()/]- 015-0
4/.f7-fAp ,3
(Zip Code)
5-/H3
APPLICANT PLEAS P,E BELOW
Type of Fixture Quan . Type of Fixture
Bath Tub with or without shower I Rough~ins
Dishwasher l l~ ater Heater
Floor Drain ...11 (' ....ter Softner
Lavatory (Bathroom Sink) ;;" U 0 Stand Pipe (Washing Machine)
Laundry Tray (lR 02 comp rtment si Ii Sewage Ejector
I Shower Stall I Backflow Assembly
I Sinks ~ I \., Backflow Assembly Test
I Bar Sink e;\V- V I '\ Lawn Sprinkler
I Water Closet (Toilet) "V ~ Other
FEE ~DULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum
Quantity
Estimated Cost $
dOl) /'
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit # ~
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ 3q. 'E5O
$ .50
$ A--IJ. 00
paidt/{)/aJ
Dab-~<3
(Office Use Only)
-1, This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
Recetiij-b'23
BYQU
fj
"~~--
/