HomeMy WebLinkAboutPlg Permit 02-0483
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
5-3-02-
I. Blue File I PERMIT NO I
2. Gold City , ./') 1 /) / /D.... d .
3. Vellow Applicant <...../~ -U "t' ~ -)
37~
(Please type or Print and sism at bottom)
ADDRESS
~ rOOa.n~ ~.{(' (\)E.
ZONING (office use)
PtLD
LEGAL DESCRIPTION (office use only)
LOT 1 ( BLOCK ~,ADDITION cA IJ /VId
- r-
APPLICANT SIGNATURE ~ ~ DATE
\..J () -
APPLICANT'PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain ~
Lavatory (Bathroom Sink) I ,--
Laundry Tray -- ----~...t .,ink I
ShQwer Stall REQUEST FOR INSPECTION
I Sinlcs SENT TO CONTRACTOR NO
I Bat Sink RESPONSE - CLOSE FILE
I Wafer Closet MAY 2003
,
OWNER
(Name)
(Address)
APPLICANT
(Name)
(Address)
(Contact Person)
Quantity
~
"3y-cL,
fJ~
PID ;:)5' Jl '-/- tJ ai-a
~ ()(}yy\MOr
~~ ~~ ~~
(Phon e)
CULLIGAN WATER CONDITIONING
€C'~0 ('I !L1I~AN WI>.y
MINNETONKA, MN 55345
~D5~) 933 7200
i.. _ (Adaress
(phone)
(City)
(Zip Code)
(Phone)
?-,- ~ :) -O~
Type of Fixture
Rough-ir,s
Water He :ater
Water S9ftner
Stand Pi~e (Washing Machine)
I Sewag, FJect<l>r
I Backfl~\'I' As~bly
l Backfl~\'I' Asst:mbly Test
I Lawn ~'p inkl,jr
I Other .
i FEESClhu~.I!:o
Industrial, CommerciL & Multi-family 1% of job cost with a $39.50 minimum
Residential, N"" One,k Two-Family $99.50
Residential, A,ldltions. t Alterations $39.50
Estimated Cost $
Building Pennit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
\5,
.5 )
(omce Use Only)
This Application ~omes Your Building Permit When Approved
Building Omdal
Paid LIe dl ReceJpt 1l.2..
,CJ. if/~'Cf~
Date By QQ.../
Date ~r ;:;. -q: 7-- 1j'
24 hour notice for all inspections, (952) 447-9850, fax (952) 44712JS