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HomeMy WebLinkAboutPlg Permit 02-0756 Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT fo. 25 . 0 Z- I. Blue File PERMIT NO 2. Gold City '()'" ,.. 0 75l., 3. Yellow Applicant '" (Please tvDe or orint and sign at bottom) ADDRESS ..gS <:3 -f.,..,ck ~[ T y- ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK (Address) APPLICANT h Ii J v1,. _ ___ (Name) ~rr- ~ 4-' N-t.t J./ /~79P J2r~ ~ (Address) (City) (Contact Person) ~~ J- ~,...IV (Phone) APPLICANT SIGNATURE ~ If' /L" ~ , 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 Ecr\O~ Sinks :r VOR \~SY :rOR- ~O Bar Sink REQ\JES O~'{Rt\C :\;E Water Closet (Toilet) SE~'{ '{O ~ _ CLOSE f\ RESYO~S ~...d!.1JULE Industrial, Commercial & Multi-family 1% of job (. _ ...nll a $39.50 minimum OWNER (Name) (Address) Quantity ADDITION PID t--V\I'h.~ ~c...~{LI~ ~~"6.J ~~:L 7'v , (Phone) 9'..s' ;2 - ~Y6 .- 5' J>.:2..6' (Phone) 9S-~ - 'YSU""}..S /, 0 (Zip Code) 1'.0.. - f?'f r,.. g' S & ? , DATE Type of Fixture / . Rough- ins Water Heater Water Softner StlUld Pipe (Washing Machine) vage Ejector tdlow Assembly ;:flow Assembly Test \ Sprinkler Residential, New One & Two-Family $99.50 Residential, Additions & Alterations $39.50 Estimated Cost $ Building Permit # 02. - 0 7 S {, PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ 3 9. 5-Z; .50 /kJ.~ (Omce Use Only) This AP~IiCatio Becomes Your Building Permit When Approved /p- 1, 5 ' O-z.-- Bull Ing Omdal Date Pai~ . dU D,te b ' (,:r - .t"2-- ReceiP:ti.~ I By ~ 24 hour notice for all inspections (952) 447-9850, fax (9S2) 447-424S