HomeMy WebLinkAboutPlg Permit 01-0774
Date Rec'd
(Please type or print and si2l1 at bv."u~)
I ADDRESS
CITY OF PRIOR LAKE PLUMBING PEU
~::~ ~~~ PERMIT NO. 01-07"'1 A ...
3. Yellow ApplicaOI I~
'7- 2-3-0/
/4-/78
8L-U6e/~ 7leA/L- Af6
ZONING (office use)
te.../
LEGAL DESCRIPTION (office use only)
LOT ~ BLOCK (p ADDITION jql/ 015 Hte..<- Z IJ D
PID 25 ..339 .. ()4-!5: -I)
,
OWNER
(Name)
(Phone)
(Address)
APPLICANT /) fa )
(Name) I ulrL ttnrleYhon _ (7'\"..e) [752 23B-f!.Oaw
(Address) 14/7~ 'A/lJebird /f7J/L NE:. l110r _{aKe~ !::J5372
(Address) (City) (Zip Code)
(Contact Person) _~;1 _ (Phone)
APPLICANTSIGNATU~~ DATE '7/2-2>/0/
-"'\]~P~LICANT PLEASE COMPLETE BELO~
Type of Fixture Quantity
Bath Tub with or without shower
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)
Quantity
Type of Fixture
/
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
I Sewage Ejector
I Backflow Assembly
I Backflow Assembly Test
I Lawn Sprinkler
I Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
dioSe /Jue .
10 ~ad-r V) \~ated Cost $ Building Permit #
- / PLUMBING PERMIT FEE $ 39. 50
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 4:f) . 00
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
(Office Use Only)
This AJf~m;1ecomes Your Building Permit When Approved
'l{///ff~.23-0 I
Buildhig Official I Date
Paid +0. dV
Date
7.. 2-3 --0/
I '
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Receipt No. / /'
I ~/!plP
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