HomeMy WebLinkAboutPlg Permit 01-0619
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
I. Blue File
2. Gold City
3. Yellow Applicant
(J.DI
71s-}J/ ~&,,/ I>~
LOT
LEGAL DESCRIPTION (office use only)
(Address) -#7 yp'
(Address)
(Contact Person) ----Ad- 6' ~ -,
APPLICANT SIGNATURE ~a,
" V
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture I Quantity
Bath Tub with or without shower I
Dishwasher I
I Floor Drain I
I Lavatory (Bathroom Sink) I
I Laundry Tray (lor 2 compartment sink I
I Shower Stall I
I Sinks I
I Bar Sink I
I Water Closet (Toilet) I
OWNER
(Name)
(Address)
APPLICANT
(Name)
Quantity
BLOCK
ADDITION
PIDZS....3t7 - Olz,,-O
C!1 roc ~
YS"7l
-:I~
r:tr,e- Iv. .!.. ~/ b---
(Phone) 7s'2 - ~ - 9r.2...
/
~
(Phone)
(City)
(Zip Code)
(Phone)
1~ -- .tVrJ'"'-- f '7&/
,
~
DATE
Type of Fixture
Rough-ins
I Water Heater
L---/-Water Softner
I Stand Pipe (Washing Machine)
REQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
(Office Use Only)
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
.3'1. SO
~.d1)
.50
$
$
$
es Your Building Permit When Approved
Paid 41J . tID
Date
~ . ZOo () I
Receipt ~3r
I By fi~
/P.7A~p/
Date
I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245