HomeMy WebLinkAboutPlg Permit 02-0053
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
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(Please tvDe or DrintlJt sign at Lu.....~)
ADDRESS ~~ a
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1. Blue File
2, Gold City
3, Yenow Applicant
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LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
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OWNER
(Name)
, (Phone)
(Address)
~
If APPLICAN~A ._ .
\ (Name) l!.Y21LfJ7e. rJ- WlnorP f.L1Lgfer Wa:tJv1fV1tphone) 76 -; - SyLj-- 70 'j 7
.~Address) /0"55 b :2... ere;' r-~ dU;//. P/'I J1(~17J "1 tff", - ~ ~ ?7/
/, /1 (Address) (City) (Zip Code)
Contact Person) VII'! ~ It. 0 O"'€ (phone) 7 P 5- 2&-1r O/<{ c;-
APPLICANT SIGNATURE A-J mate- DATE l-- /(/-02
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Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture I. Quantity
Bath Tub with or without shower I
Dishwasher I
Floor Drain I
Lavatory (Bathroom Sink) I
Laundry Tray (lor 2 compartment sink I
I Shower Stall
I Sinks REQUEST FOR INSPECTION
I Bar Sink SENT TO CONTRACTOR. NO
I Water Closet (Toil! RESPONSE - CLOSE FILE
Type of Fixture
I
'"
Rough-ins
Water Heater
Water Softner
I Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
I Backflow Assembly Test
I Lawn Sprinkler
I Other
I'"E]!; ~l.:HEDULE
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 $
Building Penn it #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
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.50
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(Office Use Only)
This Applim- sAc~es Your Building Permit When Approved
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Building omclal Date
Paid 4'-0 . CJl:J
Date J. _
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Rrece, ipt NO~II $" r
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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