HomeMy WebLinkAboutPlg Permit 01-0346
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
4--2-3-0/
~'~I~ ~!;y I PERMIT NO. 01 r tJ.Yf-(p
J, Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS " ' ZONING (office use)
(L '~/17D ~'flQrf; . [tr~ JJt,
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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(Address) IL(1LlO 'Vl u .cut K. ttll
(Address)
(Contact Pe"on) G1IM;\L (l~ ~ /)
APPLICANT SIGNATURE ~ LL
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
I Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
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(Phone) CJrJJ" L{ CtJp - l b{jfJ
(Address)
. (Phone) Cfs~ - Lt?;6 ~ '{)ilO
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(City) (Zip Code)
(Phone) (JJCl ~ q ICf - '211tJ ~
DATE
Quantity
Type of Fixture
\
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
. ~.............,....rr,... 1:';...........+,...,.....
REQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $3950 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ Building Permit # () /.,,0 YI-h
PLUMBING PERMIT FEE $ 3--1. ~
ST ATE SURCHARGE $ ,50
TOTAL PERMIT FEE $ 4-0. (/V
(Offi1Jce. U Only)
Th . on Becomes Your Building Permit When Approved
... "" 4-. 2r '). if (
. 1Juilding Official Date
Paid 40 I 0lJ
Date LJ. J I
'1'2.- .1
. ReceiWlo3 1J'l rJ
B/fif---
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245