HomeMy WebLinkAboutPlg Permit 02-0402
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please tvDe l,)r print and sign at bottom)
ADDRESS
]06L{ FoXrn//
7,ra/1
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
OWNER
(Name)
hJe'f/l )W!IAHh
Ho Jfre c;
(Address)
~;;~~ANT Moo ~ rt- Jf1 tJ ()f"t?- tJ"H7r
(Address) /0 5] 6 ;;J.. Cfq Lb ALAe h.
/) (Address)
(Contact Person) I M f.^.e f11 00 /'e
APPLICANT SIGNATURE OQ~ ~al\ ,
I. Blue File PERMIT NO 1-
2. Gold City .01 J _ t) LI () .
3. YelJow Applicant t7\ .,,{ I
ZONING (office use)
12-~
PID OlS-,-':f8$-OQQ-.O
. (Phone)
T~fJf'1t(-R.t;.e) /6 ?-1 j'q- 7097
(Jr,Vrr.pmYl S-~J 7/
(City) (Zip Code)
(Phone) 76)-.:<36- O/~ S-
DATE L/~ ;{.S-o-::<.
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture
Bath Tub with or without shower
Dishwasher
I Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
Quantity I Type of Fixture
I Rough-ins
I Water Heater
I I Water Softner
I Stand Pipe (Washing Machine)
- - -~ Pipctor
FEES\,;IUiDULE
Industrial, Commerci~ & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $ '-100 ~
CLOSED WITH SF
BUILDING PERMIT
Residential, New One ~ Two-Family $99.50
Residential, Additions'" Alterations' $39.50
Building Permit #
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) 447-4245
f~q. $""lJ
.50
I.,fd rO()
Paid % l./tJJ(){J
Date Lf~ (} '3 - V
ReceiPifl7 019
By f0
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