HomeMy WebLinkAboutPlg Permit 01-0165
The Cenler or Ihe Lake Counlry
CITY OF PRIOR LAKE
Pl-~M~/N PER'!IT
Applicant: ~/~ ./
Address: /~7L/tJ ;;.,.~ (~A
Signature: ~ ti
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Legal Description: Lot Block
Site Address: ..sLlI,? S;~ ~~&..;;,
Building Permit # . I PID #
NOTE: This permit will not be processed without complete information.
1. Blue
2, Gold
3, Yellow
File
City
Applicant
PP No. 01 . WIJ ~
Phone: 7',J.....~, q? .f'-- .I )") ....L
I -
Sub
FIXTURE UNITS
Quantity
Type of Fixture
Quantity
Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
I
Rough-ins
Water Heater
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
Bar Sink
Water Closet (toilet)
REQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$31.~
$
$
$ .50
GRAND TOTAL
$ 4-0. 0 0
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing C~de t mendments thereof.
.3fo73 RECE 3-1, "LDATE
ATfEST
Call for all in spec Ions 24 hours in advance.
16200 Eagle Creek Av. S.E. Prior Lake, MN 55372/ Ph (612) 447-9850/ FAX (612) 447-4245
An Equal Opportunity Employer
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