HomeMy WebLinkAboutPlg Permit 01-1233
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
J. Yellow Applicant
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I PERMIT NO.O /- /Z-.33
(Please type or Drint and sign at bottom)
ADDRESS 3/70 SrI/1Dt! {!AV6 ~
,
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2S -37/ - o2JI--l)
OWNER
(Name)
(Phone)
(Address)
APPLICANT 1.1/\ t\oI "-.i1
(Name) Ou t "-
~ (v\ CJeeJ I~
(Phone) U&;) ?PC., G~-
AJt~I'(\ce_ -tCY')
\f (City)
(Zip Code)
(Address)
(Address)
(Contact Person) \JO,C:'H'. ()4\ O(}.rB-
. APPLICANTSIG~;URE - / &! ./Vf,p~
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APPLICANT PLEASE 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)
(Phone)
DATE
to /~~ (I D I
Quantity
Type of Fixture
Rough-ins
Water Heater
x
, REQUEST FO
SENT TO CON~ INSPECTION
RESPONSE _ cL~~~7fE NO
.-. __f'"...._....._
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FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit # 0 ( - /2-:5 '}
:3 1~ 57J
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$
$
$
Estimated Cost $
(Office Use Only)
Date
Paid 40 ",oz.)
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Receipt N4-i 77 ~
ByF
s Your Building Permit When Approved
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245