HomeMy WebLinkAboutPlg Permit 02-1510
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
APPLIC~T J /) .." _ ' 0/ _
(Name) (')t'". L-t5..!)/1j; V()11~-'A ~.-fet::- (Phone) 7/(5- (~?(U~ t1l-.P&7
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(Address) 1573 (In,7<..A H &e. lOll I-/-/"d(!f)n LtJI ,~O/~
(Address) (City) (Zip Code)
(Contact Perso~ V rn (Phone)
APPLICANT SIGNATURE ~ ~.P DATE
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathron... C1: , '
INSPECTION
REQUEST FORTRACTOR. NO
SENT TO CEONCLOSE FILE
RESPONS -
\ MAY 2003
(Please type or tlrint and si2ll at bottom)
ADDRESS
a q LP to --:P-Ah ()ftf JAftJ..~1 n uJ
LEGAL DESCRL.t' uON (office use only)
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(Address) f} q U u 7ntxJ1Jd- -:t1;;U) n /j)
LOT dl)BLOCK I ADDITION
Quantity
'.......
1. Blue File I PERMIT NO
2. Gold City '. -J_ j''- 1/\
3. Yellow Applicant c:;;tl .:::> / u
ZONING (office use)
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PIIJ..:25 -.1 ,f~ - /J_YJ - ()
(Phone) q 5a ~ tj /)3-/tJ {5 ,-=? I
B1 ti)fG 1J1J0
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Type of Fixture
/
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE S....nJ!.DULE
Industrial, Commercial &. 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 #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Oflklal
Date
14 hour notice for all inspections (951) 447-9850, fas: (951) 447-4145
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- ,50
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Paid Llb,oo
Date
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