HomeMy WebLinkAboutPlg Permit 02-0648
Date Rec'd
ell i OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File PERMIT NO
2, Gold City ':/)'7 -()/- H
3, Yenow Applicant " lP
(Please type or orint and sil!J1 at bottom)
ADDRESS
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Htlvan
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ZONING (office use)
LOT
LEGAL DESCRu- uON (office use only)
BLOCK
ADDITION
PID
OWNER
(Name)
(Address)
APPLICANT
(Name)
(Address)
(Contact Person)
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(Address)
Q09l..101- CJ'llJ1-
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(Phone)
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(phone) qSa-q~'~17L7
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(City) - (Zip Code)
(Phone)
APPLICANT SIGNATURE
DATE
Quantity
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
Showe-1' <;:to 11
~~~i REQUEST FOR INSPECTION
Water SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
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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 Pennit # (J Z -(), H
PLUMBING PERMIT FEE $ .3~. rv
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ Af),,(/V
(Office Use Only)
This Appli~~i~ ~omes Your Building Permit When Approved
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Building Official Date
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Datr
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ReceiPt1'z,/JJJ
By~
14 hour notice for all inspections (951) 447-9850, fax (951) 447-4145