HomeMy WebLinkAboutPlg Permit 02-0781
CITY OF PRIOR LAKE PLUMBING PERl\tlll
Date Rec'd
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ADDRESS '11 lJ'f
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1. Blue File
2. Gold City
3. YeUow Applicant
PERMIT NOt' J- 781-
&u>>t west
ZONING (office use)
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Woodson. Craia
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(Phone) (q5~) Lftf1- %/1
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~;;~~ANT Norl?l~ pLumvina (phone) flillliU - 't[)'1o
(Address) ~qos etarfie{d !rIt,: SJ. J rrllJlSI fJCJfO~
(Address) (Ci y) (Zip Code)
(Contact person)..0eff NOfbtovrl (Phone) (U (j,) ~}..7"'lfD?3
APPLICANT SIGNATURE ~ DATE -M 'J.-t10'J-.
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 ECTION
Sinks REQUEST FOR lNSP ER NO
Bar Sink T TO HOMEOWN E
Water Closet (' ~PONSE _ CLOSE FIL
4/2003
LEGAL DESCRIPTION (office use only)
LOT 10 ttOCK ADDITION
OWNER
(Name)
(Address)
111lRl{-
Quantity
I<~ES\...tu!.DULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $
PIDa-5 -1 '34" 00'1-1
Type of Fixture
,
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
. Sewage ~jector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Pennit #
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) 447-98~m, fax (952) 447-4245
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