HomeMy WebLinkAboutPlg Permit 02-0101
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERl\rll1
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If.eL/1JJ =tI () I - (I Lc4
(Add,!ess)
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(" ~~~~~AfiAOO ~ ,,~~ (Phone) 1 (p 3 Ze& 0 1 qS-
(Address) \ '301.c, '2Q1'f1, ~ pl'J It Ce jCY\
(Address) (City) 1\ (Zip Code)
(Contact Person) P V-t.. Jl/\..a:J ~ (Phone).5e. ,.... (..
~ AfPLICANTSIGNATU~. ~ ~ DAT~/' \/SO 10'L
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
LauJ1c1rv Trav (lor 2 compartment sink
Sho
Sinl REQUEST FOR INSPECTION
Bar SENT TO CONTRACTOR. NO
Wa RESPONSE - CLOSE FILE
Residential, New One & Two-Family
Residential, Additions & Alterations
Building Penn it # 6 ~ 0 ( 0 (
5~ r-u
.50
t:fO - {)lJ
(Please type or print and si2ll at b.~..~~)
ADDRESS
6'LljN W/i ~7C-
.~
3:5 4-3
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
OWNER
(Name)
Quantity
rEI.." "",",ADULE
Industrial, Commercial & Multi-family 10/0 of job cost with a $39.50 minimum
Estimated Cost $
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Omce Use Only)
This Application Becomes Your Building Permit When Approved
~ , _ ~O...-6L..
Building Omdal Date
!-3()-{)L
1. Blue File
2, Gold City
3 , Yellow Applicant
PERMIT NO.02-lJ 10 I
ZONING (office use)
ez-J D
PID 25~S. OSJ-()
(Phone)
Type of Fixture
\
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
$99.50
$39.50
Paid ,/7 /
'HJ-VC/
Date
J.... JO--() 7/
R=jj~, 1/86
Byr-
14 hour notice for all inspections (951) 447-9850, fax (951) 447-4145