HomeMy WebLinkAboutPlumbing Permit #03-1304
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
OWNER '/1 ~ ~ j "'h
(Name) \.je'1rl1 ~ (.J./~k. <J...U nStJY7
(AddreSS)0 tVrJC-, tZ~ a-b~
Cui.LlGAN'iJA=fCn CONDn luNiNC
6030 CULLIGAN WAY
MINNE1'vNKA, Mr~ &&345
(952) 933-7200
(Address) (City) (Zip Code)
/ ' b <.... ~t/15 (Phone) Q5.3 - q /,;- -7?J70
- _~ DATE -f'/d?tJ /tJ3
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
REQUEST FOR INSPECTION
SENT TO HOMEOWNER.
FEB. 2004
(please type or print and sign at bottom)
ADDRESS
I S-5 7.3 ALZlOal'ck, I~ /\Lf/V'
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
APPLICANT
(Name)
(Address)
(Contact Person)
Quantity
q Zb. 0 :1
1. Blue File PERMI NO
2. Gold City 1'. ^ "? _ /..'7 A4-
3. Yellow Applicant LA..) 'J u
ZONING (office use)
PID2S3~7. tJzt>.O
(Phone)
qS-d-~~lj~91?
(Phone)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other /, _ I J ',... ).,_'
--:-. I;'.n./ ,P,' / l' -I-?" +-, / I (
. A, I v (. ~<.r.{ I (:/1 (
FEE SCHEDUL~/I/-
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
"")_/}/J PO
Estimated Cost $ ~tL.V ...-
!
Building Permit # -'.}.3 -1304-
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
'l"his Application Becomes Your Building Permit When Approved
Building Official
Date
$ 09v S-O
$ .50
$ 40.00
7 I ,--
l _ i o~ e
i .1 J
\...._-,' i (. e.,
{II".
Pai'!., --,J ()
..,-v , {J
D1J. 8 (, · 0'
ReceiP~~6
BY~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714