HomeMy WebLinkAboutPlg Permit 02-0695
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~ -/1, () 'Z-
1. Blue File I PERMIT NO I
2. Gold City .Q .., , 0" Q,--
3. Ye!low Applicant . ". l ,
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
PID
OWNER
(Name)
U\r\s
\ il <6''2-
5 dell(
~\ ~clirN-~ -t-r
(Phone) ~ -SO~ - ~'Ol
(Address)
APPLICANT (\
(Name) ~o\--ti Frn rru~v-
(Address) \ 10I Lt 0 Xf clill.Q --:Pel th
(Address)
(Contact Person)
(Phone) ctS ~ - 405---0 T7 ()
larD W l0 -f4) L33ClI~_
(City) (Zip Code)
(Phone)
APPLICANT SIGNATURE
DATE
to ill (CO?-
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain \ Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 comnA........~-.. -= 1 Sewage Ejector
Shower N Backflow Assembly
Sinks REQUEST FOR INSPECTIO Backflow Assembly Test
Bar Sink SENT TO CONTRACTOR. NO Lawn Sprinkler
Water Cl RESPONSE - CLOSE FILE Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50minirnum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
,1.'/ Q tr!J'
Estimated Cost $ -f-l-
Building Permit # 0 Z. ~ fJftr, ~.r
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ .3 t. }ZI
$ .50
$ AO_v--
(Omce Use Only)
This Application Becomes Your Building Permit When Approved
Building Omclal
Date
Paid ~ . fI'7)
Date / . ~'1
"-,, -I L
ReceiPtNo~e./" (p
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245