HomeMy WebLinkAboutPlg Permit 02-1534
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
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ADDRESS
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LEGAL DESCRL.t'HON (office use only)
LOT ~_ BLOCK \1 ADDITION L/{jJ.[JA arnil1 /
OWNER 1 ,() j
(Name) J\OI.X:.- u ale-
(Address) i5 d,~"') / ~ ) /)1Yi oLLL (J)!... 772.
I. Blue File
2. Gold City
3, Yellow Applicant
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PERMIT NO. ()(l...( S3tt
ZONING (office use)
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(Phone) Q5a. f.-/ IJ() -- 9a9'1
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APPLICAN11- . J J r-, ,^ j /1 D
(Name) ,:il fI..R/)lX> U'()LLJ"~.-L/ c:; {l6?~ (phone)
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(Address) 578 {]hI 7Zf]/ f} cS+e /tJZ/
(Aldress)
(Contact Person) \...J L ~
7/5- 3~-J't:1!t77
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(City) (Zip Code)
APPLICANT SIGNATURE
_ (Phone)
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DATE
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundrv T.....--'. SPECTION
REQUEST F~~~CTOR. NO
SENT TO CO CLOSE FILE
RESPONSE -
MAY 2003
Quantity
Ie
Type of Fixture
1
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
t4.1!..I!.S\,;I1J!,DULE
Industrial, Commerdial & Multi-family 1% of job cost with a $39,50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
11
Paid l/I); flY" R~R3
Date I'd.. -{)-tJ8-- BY~
- 1/
24 hour notice for all inspections (951) 447-9850, fax (951) 447-4145
PLUMBING PERMIT FEE $
STATE SuRCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
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.50
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