HomeMy WebLinkAboutPlg Permit 02-0286
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
3- Z8 -0 '2-
Fla wi 01- 1300
(Please tv1>e or orint and si2l1 at bottom)
ADDRESS
..3(a 0 I ro'X
If)t 1/ ~
LEGAL DESCR.1t'TlON (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(Address)
APPLICANIA .
(Name) IV(OO~ v-Moor<:- tVC1Tev
(Address) / OJ f b- ~ C( q .~ &?l ~ 11.
/) (Address)
(Contact Person) / /P1 V< rJ1 () Ol^e
APPLICANT SIGNATURE O~ /21 dfl.<-
I. Blue File PERMIT NO
2. Gold City . t) Z. -0 ztJ (p
3. Yellow Applicant
ZONING (office use)
PID 2S-3fS-008-0
(Phone)
(Phone) 76]- S &q- 70lf 7
p/'/lAr -;p n:;",,- WI",,'" ~>1 7/
(City) (Zip Code)
(Phone) 761-:l'if, -ole{.s-
?-~~t)'Z
DATE
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 I Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 comoarfmpn+ ~:_1 Sewage Ejector
Shower SUi" R INSPECTION Backflow Assembly
Sinks REQUEST FO TOR NO Backflow Assembly Test
Bar Sink .. SENT TO CONT~~ FILE Lawn Sprinkler
. Water Clost RESPONSE - CLO Other
FEES\..:I1J!.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 $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Building Permit # 0'2.. - 0 z.0~
$ 3&1.50
$ .50
$ 4O_0~
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