HomeMy WebLinkAboutPlg Permit 02-0123
~
CITY OF PRIOR LAKE PLUMBING PERMI.
Date Rec'd
DATE
APPLICANT PL~SE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom S' .'
Laundry Tray (lor 2 ~ REQUEST FOR INSPECTION
Shower Stall , SENT TO CONTRACTOR. NO
Sinks. . RESPONSE - CLOSE FILE
Bar SIOk.
Water Closet (Toilet)
(Please type or print and sim at b,. ... --)
ADDRESS
\1 ~~(p
l)w:1 tieL 1*. 55
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
VodriUlU U ut~ a.rd/
1~{f;(P ~~ ~. 513
APPLICANT rt.n~&\/\ tIln.. n V
(Name) ~'lUi1AJ1 r , ( V \U. U
(Address) JltlYfJ 1/{u1~"BLfV1
a;r
OWNER
(Name)
(Address)
(Contact Person)
APPLICANT SIGNATURE
Quantity
I. Blue File
2, (laId City
3, Yellow Applicant
I PERMITNO~
ZONING (ofticeuse)
PID
(Phone) .w~~-ao1Q~
(Phone) J1fiJl0l?JC7-' '?rI1D
lllrjlA nil ecJrJlflI
_ _ c. ~
(City) (Zip Code)
(phone) l~-- m ~lCL
1, /5/fr2,-
Type of Fixture
Rough- ins
Water Heater
I Water Softner
taod Pipe (Washing Machine)
ewage Ejector
ackflow Assembly
ackflow Assembly Test
lWD Sprinkler
I Other
,"
.rJ!..I!.S\...I1.I!.DULE
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 Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
J'fs)~~~'ltion Ber~ Building Permit When Approved
(t:-fl), .,6/;; 2"~ -02- '
t Buildi" Offidal Date
"? f. 50
.50
t.{O .00
Paid
ReceiP~_~Y/20 7
By (/p
Date
~ -1- f)l"
24 hour notice for all inspections (952) 447-9850, fax (952) 447~245
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