HomeMy WebLinkAboutPlg Permit 02-0222
-,
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
3-11-02-
(please type or print and si~ at b~~~)
ADDRESS
I. Blue File PERMIT NO
2. Gold City . OZ.-07/ z.
3. Yellow Applicant
\10310\
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(\ A,,1U{' -
5537;),
ZONING (office use)
pt/SO
LEGAL DESCRIPTION (office use only)
PID2.5-835 - 03(0-0
LOT BLOCK
ADDITION
OWNER ~.
(Name) - I f""I'f'C'\ f).p ffi\J5JL.
(Address) l S~ <'A_~ 0_~yJ-e.., \
(Phone) !15~~ da-lo - Sd-S \
APPLICANT
(Name)
CULLIGAN WATER CONDITIONINu
0030 elll LIGAN WAY
MINNETONKA, MN 55345
1rsa.)...9?~..1?nn
(AdHressJ
(Phone)
(Address)
(City)
(Zip Code)
(Contact Person)
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(Phone)
J)~,
DATE
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APPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Il' Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall REQUEST FOR INSPEC'fION Backflow Assembly
Sinks. SENT TO CONTRACTOR. NO Backflow Assembly Test
Bar Smk RESPONSE _ CLOSE FILE Lawn Sprinkler
Water Closet~ MAY 2003 Other
"'~.a;.t..a;.r ..,_
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 $ ~
BuildingPennit# OZ -022. 7
,PLUMBING PERMIT FEE $
'STATE SURCHARGE $
TOTAL PERMIT FEE $
1=5""', .g:::C .:3<1. '5 D
.50
~ ~ ~~ 4D.DO
(Office Use Only)
This Application Becomes Your Building Permit When Approved
t?h1~ ~ -I '-02-
BUi~al Date
paid4-0 . 0 D
Date,.3 It
- -0 2-
ReceiP~( z- q I
By f~ .
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245