HomeMy WebLinkAboutPlg Permit 01-0779
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PEAAul
(Please type or print and si2l1 at hw ..Jw~)
ADDRESS
1'5307 W,'/J5
I. Blue File I PE
2. Gold City
3. Vellow Applicant
OO/-77CJ I
{Jal"kCv"ty
ZONING (office use)
fZl
LEGAL DESCRIPTION (office use only)
LOT ~ BLOCK C, ADDITION !/~ /~+-
PIDc:25- 37'.... or~- 0
OWNER
(Name)
(Address)
{){" ~
Ot;i (/' Is
(Phone) 7 G J... )"/"$--/ J )"c{
APPLICANhA
(Name) 'Yl/JON! r/-tulJQL:;e. Wt:f.IPr- ~f-/fI1{'I1~(Phone) J1, 1- Jfjqt''20P7
(Address) I 01s 6 - 2 qq tit (:tI ~ YI. fJ /'II/Jr P fl::J" tI1 n, s-n 7/
.11 (Address) (City) (Zip Code)
(Contact Person) , A7I IN JIJ1 (JO.-e (phone) 761- JlJCi - Q.s" -Z/ \.
O~ Pk1~ DATE 7-J..cr-ol
APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
. Bar Sink
I Water Closet (Toilet)
Quantity
Type of Fixture
J
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
REQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
JlI!.I!. &..D.l!.1hn..ri
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 $
B1.lilding Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
~1i,S"'o
SO
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(Ornee Vie Only)
This Applieation Beeomes Your BuildiBI Permit When Approved
BuDdlnlOOldal
Date
Paid Jh 0
..",,0
Date? -cl '1-0)
Re:;~,? /
BY'~
V
24 hour notice for an Inspections (951) 447-98S0, fax (951) 447-4245