HomeMy WebLinkAboutPlg Permit 01-1222
CITY OF PRIOR LAKE PLUMBING PERMIT
1. Blue File
2. Gold City
3. Yellow Applicant
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ADDRESS S' -
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LEGAL DESCRIPTION (office use only) .
LOT 1 BLOCK ,AADDmoN)~ .3 rei
OWNER AtJ) / J. ~ jI\.... , ~
(Name) I'~ (..................C,L./o I'l() 1'-1 ~-r I f '7 (Phone)
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APPLICANT ~ /) /'~
(Name) ~--IV'-I'./ i' - ..- a pi
(Address) ~.L{: ") c;/f/ ,.j;r~ ' ~.,I&V'
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity I
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain / X Water Softner
Lavatory (Bathroom Sink) . /1 Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink I -' ,-
Shower Stall I REQUEST FOR INSPECTION
Sinks SENT TO CONTRACTOR. NO
I Bar Sink RESPONSE - CLOSE FILE
I Water Closet (Toilet)
(Address)
Quantity
h14il~o L s. ~
Date Rec'd
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PERMITN<t?/_ J~;)-d-
ZONING (office use)
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PID (15-3 73-tJ/1- ~
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(Phone) 90-2 - Y .Js'....,,,_?~ ) /)
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(City) '-.,-- {Zip Cod~ /'
Type of Fixture
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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
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
Efl- 5'"0
_ ~.50
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(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Paid $1f{},~
Date ag-o
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-t .
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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