HomeMy WebLinkAboutPlg Permit 01-1352
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3. Yellow Applicant
(Please type or print and si~ at bottom)
ADDRESS
/C,730 \I)-I'd\0 --OvV\e. So~e,st
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID Z5-zA-F;-OZS-O
~=~R tv\c N\o...hdV\ } Mo.-v-K
(Address) /(p7JO W;/lQ)J L.n 6. rJ.
(Phone) (qQ) Lj 1./ () - I fo38
APPLICANT l \ - b l i"'\ ,
(Name) ".lO~ OWl .l\,);\N\\o i ^(t
(Address) 2t:}tJS u;~h~/d Av~. ~~.
(Address)
(Phone)
MDls
I
(CIty)
[(Pl1-)827- Lj-t)33
5'Si/tJ?
(Zip Code)
(Contact Person)
APPLICANT SIGNATURE ~~,.---
/"P
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink) RE UEST FOR INSPECTION
Laundry Tray (1 or 2 compartI1 SE~T TO HOMEOWNER 2/03.
Shower Stall ONSE CLOSE FILE
Sinks NO RESP .
Bar Sink
Water Closet (Toilet)
(Phone)
-
DATE
/1/23/.0/
Quantity
Type of Fixture
r
Rough-ins
Water Heater
finer
e (Washing Machine)
jector
Assembly
Assembly Test
I _H" ~Y' inkIer
Other
FEE SCHEDULE
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 Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
31. SO
.50
qO. dO
(Office Use Only)
Thh AP~our Buildlug Ji~;;.~~T"Ved
Building Official Date
Paid 4-iJ. 0 0
Datel f ,30 -01
R1IJee. 04tJ95~
By
~
I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245