HomeMy WebLinkAboutPlumbing 03-0948
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT I. I g. 03
riLE vfo:;-o 'i 2-/
I. Blue File PERMIT NO
2. Gold City . Os .- tJ 9 /LA.
3. Yellow Applicanl 7" V
,0 _ (Phone)
j;t!fJ@~ DATE
4PLICANT PLEASE CQMPLETE BELOW
Type of Fixture ~ntity
Bath Tub with v' .. :lL'ut shower , ~ - Rough-ins
I Dishwasher Water Heater
I Floor Drain I Water Softner
I Lavatory (Bathroom Sink) ~ I Stand Pipe (Washing Machine)
I Laundry Tray (lor 2 compartme~t ~. _ ... 'i l. ~ I Sewage Ejector
I Shower Stall L~ ~ -\ ,.. ~ I Backflow Assembly
I Sinks \ O?)f., Backflow Assembly Test
I Bar Sink iii \ .." ~:1i--1/\ Lawn Sprinkler
I Ware, Closet (Toilet)\.;.l V V..-a-rl' I "J I Othe,
'1EE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
(Please type or print and sign at bottom)
ADDRESS
I L/Lf 08 Lf/2-tJtJ/Lr-70t6 c?L (/0
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
OWNER :(j II &I/c~
(Name)
(Address)
APPLICANT
(Name) (Phone)
(Address)
(Address) (City)
(Phone)
(Contact Person)
APPLICANT SIGNATURE
Quantity
>c
)(
)G
ZONING (office use)
.Ie. 2-
PID
91::1 - 171- <'07J~
(Zip Code)
'7 j f/o3
Type of Fixture
Residential, New One & Two-Family
Residential, Additions & Alterations
Building Permit # 0 7 ~ 0940
:5'9. 5V
.50
-+0. 0 0
Estimated Cost $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid 4-tJ. c./lJ
Date1 , i,a >
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
$99,50
$39,50
Receipt NOh,
1-t.<! (; Z
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