HomeMy WebLinkAboutPlg Permit 05-1241
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO
2. Gold City '0""- . /.2 A_/
3 . Yellow Applicant .:::> ..,..-
(Please type or print and sign at bottom)
ADDRESS
5CO~ W C3:::lIL PO, n I TY- t~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID C). ~ '" fO I, Ooq.. 0
OWNER I ·
(Name)~ln\'fO.C:; Cl7ay-pi+.
(Address)~Q;~ ~
((~") '-4Q')-2Dt rf 0
APPLICANT
(Name)
CULLIGAN WATER CONDITIONING
ov.)vetJL1.IGAN WAY
MINNETONKA. MN _55345
(Address)(952) 9;:S;j./~UU
(Phone)
(Address)
(City)
(Zip Code)
(Contact Person) (Phone)
A.PPLICANTSIGNAT~..k"\jL~C;rb~.CYl f...4~ _ DATE I C5>/gjr5
APPLICANT PLEASE COMPL~ELOW
Quantity Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
Quantity
Type of Fixture
I
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
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
Estimated Cost $c9(:X) ~
Building Permit #
Building Official
Date
$ :...JrlSO
$ .50
$ Lt:::bOD
Paid 1"P-
Da~l. 7. r. (j r
ReceiPt1"Os (j f ~ /
ByL
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PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
.---J This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
ADDRESS
DATE TIME
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rOO~ w es /-CJq~ /;/ d
SCHEDULED
CITY OF PRIOR LAKE
INSPECTION NOTICE
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~~ SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL R REINSPECTION BEFORE COVERING
Inspector: . Y Owner/Contr.
, y
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSIIOTl