HomeMy WebLinkAboutPlg Permit 01-1401
Date Rec'd
CITY OF PRI~R L,AKE PLUMBING PERMIT /)(,1'1 ~
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1. Blue File
2. Gold City
J. Yellow Applicant
(Please type or print and si2Il at bottom)
ADDRESS J
~y~&.- F;jf/t~' I Trt'L)')
LEGAL DESCRIPTION (office use only)
LOT IOBLOCK (() ADDITION WtV-lSrvl AfVIV /?S AD IJ
$'~!AV\ G11,1'1 J.,.,V1. ,
(Address) lYSE - r;;/~1 I / Nq 1
~~~;~~ANT Irll1Y'L - YJIlHJrl- U) It'h, -L t< ~ / ) ~ (Phone) 7!'.J.. -c:; g h r tJ I t./~
(Address) l~f77- 2AItt~ C-lw_ ~, - 5h/~t- 5~ _rJ)g
(Addres~ A (Ci{y) (Zip Code)
(Contact Person) U"f\tC.- fYf.o{)V"l- (Phone) '){;? - ,;;Jg" r tJl y~
APPLICANT SIGNATURE ~-_._- DATE /aJ-/Y-tJl
( APPLICA:NI l"LEASECOMPLETE BELOW
Type of Fixture I 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)
OWNER
(Name)
Quantity
PID Z~- ~"'7ca -080-0
(Phone)
q S'cJ -.)~O -co?g8 I
Type of Fixture
Rough-ins
Water Heater
I ~ater Softner
Stand Pipe (Washing Machine)
T"'1~ __+",...
REQUEST FOR
SENT TO CON INSPECTION
RESPONSE _ cI~~~~tE NO
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum
Estimated Cost $~
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only) ...
, Th~ffi!tr.},..lf.n Become. Your Building P.rm~Wh,. Approved
;::-u l~ I 2-/, of- /0 ,
. Bui(ding Official ~ - . Date
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit #
"'"' ~ -
$ .....I~'.)
$ .50
$ 40. (Po
Paid
tJOb -
Date I f
h-" 4r 0'
Receipt No.
+11 a(
By (Ll) ~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
12,./3
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