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HomeMy WebLinkAboutPlumbing Permit 04-0303 CITY OF PRIOR LAKE PLUMBING PERMI. Date Rec'd 4-,1AJydd.- 1. Blue File PERMIT NO 2. Gold City · o-j ~3 O? 3. Yellow Applicant ~ :...;) (Please type or print and sign at l.. ~~...m) ADDRESS 5'1/2 rq,wll /)Je-.ui~w CwLl~ 5E ZONING (office use) LEGAL DESCRl.t' lION (office use only) LOT BLOCK ADDITION PID z,s-. :n t:}. wS: 0 .~:R z;:~ ~~ ~ . (Address) (Phone) ~<;.). ~~r 7"%0 g. APPLICANT (Name) (Phone) (Address) (Address) (City) (Zip Code) (Phone) (Contact Person) ,r-\PPLICANT SIGNATURE DATE Quantity APPLICANT PLEASE COMPLETE BELOW Type of Fixture Quantity Bath Tub with or without shower Dishwasher Floor Drain Lavatory (Bathroom Sink) Laundry Tray (lor 2 compa. Lment sink Shower Stall Sinks Bar Sink Water Closet (Toilet) Type of Fixture Rough- ins /~ ~ Water Softn~ '" ~tand Pipe (Washing Machine) Sewage Ejector / Backflow Assembly / Backflow Assembly Test <tr~ '-- eawn Sprinkler Other FEESCI1J!.DULE 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 Estimated Cost $ Building P"miit # 0'1-_ CJ3a3 PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERl\'.l.l.l FEE $ 3~$b _ .50 4()~OO (Office Use Only) /~ This Application Becomes Your Building Permit When Approved Building Official Date pai~.. 0-0 Da~,U~ Recej)t No~ gl crtR 'I) By /. 24 bour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Ave., S.E", Prior Lake, MN 55372-1714 \ ,...- O~1E clt'l Of p~ v.'(!&. 1~I'EC'{\Otl1lO'f'CE IJ.. ~ ~ ,s>~SS ...... CO""' , "" o'fltlER -=--------== pEfUAtt tlO. p~E tlO. =--------::\I,.91tlG fl.\ o foO't\tlG 0 ",EC" fl.\ 00.,.\lf' o fO\ltlO" 110tl 0 ...." 1Efl.l\ 00~f' v.""tlG 0 S~" ~ ~\I"" '{lOti 0 pI..Il,.6ltlG f\tII'\. f\w.'- 0 ",EC" fItii'\. ~ 5ttE ItlSf'Ec1\OtI S COtAtAEtl"S~ SC"'EO\l\..EO ~f-- ~~ ----------- ~~I,:-UtIG O COtA~v.\~ ftv.CE ~\ o f\~E"'" CE f\tl~\.. o f\~~~ o GJ-5UtlE ",'Il151 o ::=------ , ~~OCEEO h Il"- 5" '{\Sf "c10'll"/ · ~ '~~IUl"-C1 "c1\Otl "tlO f''IloC:tl5f'EC't\Otl6EfOIlE CO~tlG o colUl"-c1 "..oil"-. c"'-\. fO'll · - ----------- .f o<""'r1C.,o\r. .---------:: n""'~ . 5 Itl p..tf'lp..tlCE. I~or. __ _ tlSPEc1\Otl '14 I\OU'" 441.$ SO fOR mE tlE~ I 1It:Al-1'1I " s,4fS'('Y1 cp..\.\' foB \,OOB rIlIlSOJ'iAL coPS )lliQOI)lli~SJ'i1'S,tJtli """"" ~