HomeMy WebLinkAboutPlg Permit 01-1238
1. Blue File
2, Gold City
3 , Yellow Applicant
Date Rec'd
I I-I -'0 /
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~31~ '--
PERMIT NO.O/_ /231'
CITY OF PRIOR LAKE PLUMBING PERMIT
~ress) 11/J
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APPLICANT SIGNATURE~.i-.___ DATE
, _... -
A~eA:NfPLEAsE ~~PLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (1 or 2 compartment sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
(Please type or print and sign. at bottom)
ADDRESS I J
J5"~b1-
I-- -4,'( tv ""- Y
1/,' J I~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
'A..)e III ~WlAt1)AJ
J
Hr,W1e~
(Address)
APPLICANT
(Name)
J!i/)t^!- - y{;( Ot' tc LV,f- W
(Address)
(Contact Person)
-.
Quantity
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $
ZONING (office use)
PID
(Phone)
(Phone)
7 b~, d g b-- CJ I t.J ~
(City)
(Zip Code)
7(p~--cJ~b ~OltJ~
/ I -1-0 I
(Phone)
Type of Fixture
I
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
. --1.1., Tp.<;:t
;:-Z:i~~FOR INSPECTION
RESPONSEONTRACTOR. NO
- CLOSE FILE
Ke~IU"'u"a__, _
Residential, Additions & Alterauuu"
)
J
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
.39, s-O
. .50
q~. UU
/
Paid 4-1J ~ {f7J
Date I
/ -I - 0 I
Receipt No. 4-07f" J
I, .
By $'-
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