HomeMy WebLinkAboutPlg Permit 01-1034
Date Rec'd "
CITY OF PRIOR LAKE PLUMBING PERMIT
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(Please type or print and sign at bottom)
ADDRESS
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C37-1)
I. Blue File I PERMIT NO ~
2. Gold City . 01-.. J ^ '2
3. Yellow Applicant LU W
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT S' BLOCK ~ ADDITIONcrJlfZl)/ JAou ~~ tel
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PIIb7S-- o7'1~O /3-CP
(Phone)<1S;;> -LjL6-- J J I,t/
(Address)
APPLICANT
(Name)
vUL.i..IGAN 'y~AT='? ~ONDITI~hl:Hti@
6030 CULLIGAN WAY
NE:TONKA ~11'1 c;.c;.~
(Address) Mil" (952) 933-7200 (City)
(Contact Person) /"".. (Phone)
APPLICANT SIGNATURE ~ ~ ~ _ DATE
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
I Dishwasher
I Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
(Address)
(Zip Code)
C(I ~/tJ J
Quantity
Type of Fixture
Rough-ins
Water Heater
I Water Softner
I <;(.hmcl Pine (Washing Machine)
I
REQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
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
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Estimated Cost $.dlJ)..;;.--
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$ 41tJ!-c;l.
-~ 9 !ii2-
.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
paidtbl/tJ I a!2--
Datcq_ ~- 0 I
,
Rec~
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245