HomeMy WebLinkAboutPlg Permit 02-0743
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File I PERMIT NO I
2. Gold City . A .., _ "7//"2
3. Yellow Applicant . VCJ'-. /LV.
ZONING (office use)
IS D
LEGAL DESCRIPTION (office use only)
LOT II BLOCK (ADDITION W
PIoJ.S3fy-OI/
OWNER
(Name)
(Address)
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,
b \0 ~r\
rOl,
~u ra Y\-t-
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(Phone)
~Yo ~?foD
APPLICANT
(Name)
(Phone)
(Address)
(Address)
(City)
(Zip Code)
(Contact Person)
(}/avw--f t'~_<-~~
(Phone)
APPLICANT SIGNATURE
DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity
Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 com pal
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Quantity
Type of Fixture
Roucl1-ins
COVERED WITHOUT INSPECTION
CLOSE PERMIT 2/14/03
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Backflow Assembly Test
Lawn Sprinkler
Other
7i~k~
Resid~WO~amrIY $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
~q- 50
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PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
'/01
'-/}j-(J ;t-. By
'3/7'
Paid
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714