HomeMy WebLinkAboutPlg Permit 02-0620
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PEM...
I. Blue File
2. Gold City
3. Yenow Applicant
I PERMIT NO.~~ ~ ~
(please type or print and siltll at Lu....._)
ADDRESS
6:2;l'S 'J6fft/lS fA-55
ZONING (office use)
RI
I
LEGAL DESCRIPTION (office use only)
LOT c;2.sLOCK 3 ADDITION / A ),//nA)AyJ(://i'l
v ... -
'1st-
PID ~ ~ 3 7fo- 02q.-O
OWNER
(Name) ~t,JS ~
(Phone)
(Address)
APPLICANT
(Name) Mno!lF ~ I'1na/IL l-JAnlL
. 13
(Address) II? 53!:, ;2. 99 AVe PD ·
(Address)
(Contact Person) ~r
JliBt~ (Phone)
P/li~CFM
7'3 -3$'7-7037
SS7 7/
(City) (Zip Code)
(p~one) 76'3 - ~ f'6 ""6/l/f
DATE ~ - ,). 9 "'O'A.
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APPLICANT SIGNATURE ~U
./ /';'
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 ,~/" ~ D 1\
Shower Stall C I ,tv ~ _ \ ()J-
Sinks . ~'~ ,
B~S~ U.
Water Closet (Toilet)
Quantity
Type of Fixture
.::t..
Rough- ins
Water Heater
. Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SLltEDULE
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 $
~ '1- S-O
.50
C-j().
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid J 1 _ R~cyiptNo.
(0. l-f d--./o;h
D~ _ d-5T-cxJ- By af ~
(I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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