HomeMy WebLinkAboutPlg Permit 02-0374
Date Rec'd
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CITY OF PRIOR LAKE PLUMBING PERl\tlll
(Please type or print and sian at bottom)
ADDRESS
LllPOl
CJj\waclO gr - 6 G
LOT BLOCK
LEGAL DESCRIPTION (office use only)
ADDITION
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{Addre~ (City) (Zip Code)
{Contact Person) (1~0Yy ~ (Phone) - /
APPLICANTSIGNATUREN,r/J ___ DATE #'~~
/ V ~ e;; ________ . , .
, 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
Shower Stall
~:~ink . REQUEST FOR INSPECTION
Water Closet t SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
OWNER
(Name)
(Address)
APPLICANT
(Name)
(Address)
Quantity
Industrial, Commetcial & Multi-family 1% of job cost with a $39.50 minimum
4-16 -PZ-
1. Blue File
2. Gold City
3, Yenow Applicant
G (office use)
PID
(Phone) a69J - Y40 - 51l~
Type of Fixture
I
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test.
Lawn Sprinkler
Other
ResidentillI, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ Building Permit # {}'l ' 0 J 74-'
PLUMBING PERMIT FEE $ :.l ~ ~
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ ~ _f/V,
(Ollke Use Only)
This Applicatio.. Becomes Your Building Permit When Approved
flIlI,j-
Building omelal
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Date
Paid ,n I
4-0, r/V
Date
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Receipt N~ /114-
By~-
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245