HomeMy WebLinkAboutPlg Permit 02-0410
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
4--z~ ..,()'Z-
~1f/
~
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Trav (1 or 2 comoartment ~ink
Sb.ower :
Sinks REQUEST FOR INSPECTION
Bar Sink SENT TO CONTRACTOR. NO
Water Cl RESPONSE - CLOSE FILE
(Please type or Drint and silm at by..w~)
ADDRESS
Wild- 0 YOJYWttl\
\tJthYV5
LEGAL DESCRL.t" i iON (office use only)
LOT BLOCK
ADDITION
OWNER
(Name)
\0rm1lh
NQ\\C~
\0~LM- (AYl~lQ VetfclOau
~~;~~ANT ~~tm fY\4JY
(Address) \V1L{D Yv'Qd_Rlf, .~rn
hAddress)
l'1tJYJlj ~. .
APPLICANT SIGNATURE ~
(Address)
"--'"
(Contact Person)
Quantity
I. Blue File PERMIT NO
2. Gold City ../7~ ~ 4-10
3. Vellow Applicant (/V
NW
ZONING (office use)
PID
(Phone) CD~ -~LJo 4dOY
NW
(Phone) qSd--Lf05>~77n
Vi UJ\ ~1) , 5qOltL/
(City) (Zip Code)
(Phone)
DATE
cr'V1Jb~
Type of Fixture
/
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backt1qw A~sembly
Bac~dw A~sembly Test
Lawn! S pri~ler
Othel
. ~~~S~~DULE
Industrial, Comm~iaJ & Multi-family 1% of job cost with a $39.50 minimum Residential, NI:W One & Two-Family
.. R~identiaJ, , I\c lditi,s & Alterations
Estimated Cost $ Buddmg Permit # () 1...." 0 f:Ir I tJ
PLUMBING PERMIT FEE $ :3 9. ,6-0
STATE SURCHARGE $ lso
TOTAL PERMIT FEE $ ~ . () l11
(Offiee Use Only) I '
ThIsAPPll~..Yo.rB.IIdIDg;:I;~(J~rovod. :'~'O-,.IO:..I. :lliP~~O (7J1
Building Omclal Date T ~ l.- ~:-1 c) 1-
14 hour notice for all inspections (951) 447-9850, fax (951) 44~""145
$99.S0
$39.50