HomeMy WebLinkAboutPlg Permit 02-0619
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERl\1.1T
1. Blue File PERMIT NO 6
~~ ~ ~~- /q
3. Yellow Applicant U CJ1.
(Please type or orint and si2l1 at t~...~~)
ADDRESS
331:A.
G IS',J W '" ~/l.
T/l/JI f
,JI/Il
ZONING (office use)
R~
LEGAL DESCRIPTION (office use only)
LOT31BLOCK d---, ADDITION ~lj~ & ~
I / (/ -
PID :?~" 35 d -6C'lr"~
OWNER
(Name)
WE'" 5 IYVtrJ
(Phone)
(Address)
APPLICANT 11...
(Name) MoOIl€ + IT'oollE WlEJ'CIL
(Address) J () ill ..:2 9' ~ A tG. ~,
(Address)
(Contact Person) nil Vf /l1oof/.e
APPLICANT SIGN~TURE f' I/J "1 {j y
v '
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom ":~1,\
Laundry Tray (1 or2 REQUEST FOR
Shower Stall INSPECTION
Sinks SENT TO CONTRACTOR. NO
Bar Sink RESPONSE - CLOSE FILE
Water Closet (Toilet.
uMrP!ftJ1-{phone) 7" 5- 3stf -7077
(J;2./,J([-m~ :;-5171
. (City) (Zip Code)
(Phone) 7c. 3 -;2Sb"""OI<fS-
DATE s: - ;2JJ - d?..
Quantity
Type of Fixture
:::L
Rough- ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
}4]!;]!;S\":.nJ!.DULE
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 #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
,'i q bD
~ .50
J.f g_....
(Omce Ule Only)
This Application Becomes Your Building Permit When Approved Paid .-r J Receipt No
. Jf 0 ,CJV q;:i/O C}.
Date By CC/
BulldlngOmcial Date ~ -a9-oo-.-- U
14 hour notice for all inspections (952) 447-9850, fax (951) 447-4145