HomeMy WebLinkAboutPlg Permit 05-0181
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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
APFLICANT /.? L . ~ ~ . A
(Name) nourf /) vIII neJdLft
./
(Address) .30 7/ ~ VUt./c:.. VI'. N N
(Address)
(Contact Person) ;:Ji'1 11.t. ., ~
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APPLICANT SIGNATURE 0"'- ~/~ DATE.-3 - 8-os
/ jAPPLICANYPLEASE COMPLETE BELOW
Wpe of Fixture Quantity
Bath Tub with or without shower Jfi t j
Dishwasher r ~ '-$t!t:fr
Floor Drain LJ
Lavatory (Bathroom Sink) .. .~.
Laundry Tray (1 or 2 compartment si
Shower Stall
Sinks
J Bar Sink
J Water Closet (Toilet)
(Please type or print and sil!;n at bottom)
ADDRESS
3D, I WOOD Dud DJ-. N W
LEGAL DESCRIPTION (office use only) r
LOT/'1BLOCK d ADDITION W~cJ2;
:30l
~~~R J{o/x.r-!- t/ ::Jj/l tf?eik-
q5':J.-2U-Z~~ J
(Address) 307/ WOOD Dut.X.. VI'". !\J tAl
I. Blue File
2, Gold City
3. Yellow Applicant
I PERMIT NO.S- /~ I
ZONING (office
use)
- .,'~
Plrb25 -3377- OS~ -0
(Phone)
(Phone) CJ5~' ~t.o - ;;;.$9 ~
J) I C, I' L a...b.- ~ 5 3/ ':l-
(City)
Quantity
I
I
I
I
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum
Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
(Zip Code)
(Phone)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Eiector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
.3'(,5"0
.50
40.00
pait(O ,---
Da~ --- /3-S
Buildin!! Official
Date
Receipt~,fo~/7
I By Of
1_
0'
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eag'e Creek Ave., S.E., Prior Lake, MN 55372-1714