HomeMy WebLinkAboutPlg Permit 02-0490
CITY OF PRIOR LAKE PLUMBING PE::lU\tUI
Date Rec'd
LEGAL DESCRL.t'nON (office use only) J
LOT/1BLOCK I ADDITION r:J~A1j I)~ /57
, .
OWNER "12. , L . _
(Name) ucw~! Lnttt'k.<;
(Address) /5G,85 thff'h ~ Itve..~ N. t,V.
APPLICANT l \ \ _ \ ""'0\ \_
(Name) NOrO\C'lYY\ \ \UNV\D\~
(Address) 2Oj()S &J~/J.e-)d PrY ~ . ~ .
(Address)
REQUEST FOR INSPECTION
SENT TO HOMEOWNER. NO
RESPONSE - CLOSE FILE
4/2003
4 _ _ ____..-.u.. .... .......-:.n.i::Jr:... '-'v~.... ...:I!.II'E BELO \\'
(Please type or print and si2ll at bottom)
ADDRESS
lS'fo'85 HlOhlM1d
Ave. 'l\VJL ~ t \tJ.
. (Contact Person)
APPLICANT SIGNATURE
Quantity
Type of Fixture
Bllth Tub with or without shower
0: shwasher
Floor Drain
Lavatory (Bathroom Sink)
Lfundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Q....."
(
FEE SLlUDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $. ,,~
I. Blue File
2. Gold City
3. Yellow Applicant
I PERMIT NO&,J. - tP#QC ~
ZONING (office use)
R /5-lJ
(Phone)
PID~-1J./3- (j/?-O
(&fSZ) l/"7-">~
(phone)
{Ct,\2} 127- '/()s3
5"~'1OK
(Zip Code)
~~~
I
i
me) I
_ DA\k
Irl'ype of Fixture
Rough-tnsl
Wate). IJeatet
W ater ~oftn~r
Stand Pipe (Washing Machine)
. Sewage Eje,*or
Bac~dw ~sembly
Backfldw A~sembly Test
Lawn S pri~ler
Other
I
Residential, New On ~ & Two-Family $99.50
Residential, <\( ditions & Alterations $39.50
Building Pennit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 44~'" .245
3~ .:$"0
50
" () .10,')
Paid J I (')0
"7 '() I
Date :5- -1~ 0 d--r
ReceiIJ.?J:.b 0 /
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