HomeMy WebLinkAboutPlg Permit 01-1243
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or print and si~ at bottom)
ADDRESS
I. Blue File
2. Gold City
3. Yellow Applicant
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I PERMITNO.OI_Iz451
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ZO~~CJ (office use)
LECJAL DESCRIPTIO~ (office use only)
LOT BLOCK ADDITION PID
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OWNER IJoJ11t' C
(Name) (Phone)
(Address)
APPLICA~T It~N_ -;f//~ ~f 7b?~ a~b-- t1/yr
(Name) (Phone)
(Address)
;'\Address) /'.4/1 (City) (Zip Code)
(Contact Person) / ) ~ vtL f/J" t;Jty ~ (Phone) ')kJ.Jr- ,;)K'b -CJ / 'YS-
APPLICA~T SICJNA TU';'E . ;;::;:-~ ~- DATE J j - J - tJ /
~P~:N~ 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)
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
!
..... ... ~ '\
REQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
I VUl~l
FEE SLt1.EDULE
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 #
PLUMBrnG PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
31.SCJ
/It) .uJO
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 41, tV
Date/I_I _ of
ReceiPt~) 7 f1'
By A'IIA-
I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245