HomeMy WebLinkAboutPlg Permit 02-0806
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
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(Please type or print and sign at bottom)
ADDRESS
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/530Lj
LEGAL DESCRIPTION (office use only)
Loid-f3LOCK L{ADDITION R~a/ ttJ.esf-
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OWNER
(Name)
(Address)
I. Blue File
2, Gold City
3. Yellow Applicant
PCL 5S
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PID;J~ -',~fi:J- 0 ~()
(Phone)
APPLICANT ~ {It. -, ,..,.J.,. .J:>.~
(Name) f2 tV?~ I jJ..L:;z.f (A l/-erg (J LJJJkione)
(Address) I f..t, ~40 fredCc-{e 'PfA-cfIt I ~b;j)e---'
. (Address) (City) (Zip Code)
(Contact Person) (Phone)
APPLlCANTSIGNATURE'~~ DATE
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink REQUEST FOR INSPECTION
Water Close SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
Quantity
Industrial, Commercial & Multi-.__..,/'. ~..nJV(} "mil Wlm a ~j9.50 minimum
/ - 3 -0 2-
Type of Fixture
I
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Ornce Use Only)
This Application Becomes Your Building Permit When Approved
Building Ornclal
Date
3q.5C)
50
1/4 ,oU
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Receipt Nq} 3 7)"
By ~
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Paid
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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