HomeMy WebLinkAboutPlg Permit 02-0773
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or print and siRll at bottom)
ADDRESS
~ .~"' ()7..-
1. Blue File PERMIT NO I
2. Gold City . O? -0""'" ?
3. Yellow Applicant e,.. , 1->
34/5
~'-Y AI W I't / t;/K- 7Jer1 J ~
ZONING (office use)
~;~~~ANT (YtfScfT-C&/VlOO flE l..LAtft UE6't~tiM(Phone) 7' 1" 3f1'" ')J).. J
/63310 ;). qf~ f rti/vCt ft,A1
(Address) (City) (Zip Code)
(Contact Person) ()aJtf /'1fJoflf (Phone) 7(. 3.,.,,21' ~ O/t.}J
APPLICANT SIGNATURE /f(}: 1; tit DATE 19 ~ ;2.{ ~O?
'/ /'.
PPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (1 ~-" M"......<>rtmpnt <:ink
Shower Stall
S. k . REQUEST FOR INSPECTION
In S
Bar Sink SENT TO CONTRACTOR. NO
Water Closet l RESPONSE - CLOSE FILE
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
OWNER
(Name)
I (Address)
(Address)
Quantity
PID
. (Phone)
Type of Fixture
!
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE Sl.;.tU.,vULE
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 # l),' OJ, *$
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This APP1J7I~n J~comes Your Building Permit When Approved
Ufti ~ . U .O?
Building Official Date
3~50
.50
7'0. df)
pai~. 00
Da~. z,.t, . 07
Rece~~.s-7
By fPP ·
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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