HomeMy WebLinkAboutPlg Permit 02-1585
o~
Cy
o
\ ~l,q 6 ';A
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
PERMIT NO.~~_ /5f~
A . zRrl6-=l
e
PID.;l,t;" - ()ct 3- tt/d-'-D
(Phone)~5~.. ~J7 - '-I4t/l.c
L Blue File
2. Gold City
J. Yellow Applicant
(Please type or orint and si2l1 at bottom)
ADDis:J,)?3 2d9-e<.0olu- ~
LEGAL DESCRIPTION (office use only)
LOT~BLOCK ( ADDITION rn~~ p~
&~e~IVf3OA b \.Skw \c
SA-mlL
(Address)
APPLICANT L-IY'l If. _I /1
(Name) -/1 It. '21 u../ f.tL 9-' <--Jty{) \
(Address) Lo05 );:l-!!.&A 0 q .
(Address)
(Phone) q5~- q8/- q I "/~
WOoW ('55-~t/3
(tity) - (Zip Code)
(Phone)
(Contact Person)
Quantity
~~~ - . DATE
~L)~~EASE 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
Sinks REQUEST FOR INSPECTION
Bar Sink SENT TO HOMEOWNER 2/03.
Water Closet (Toil NO RESPONSE. CLOSE FILE
APPLICANT SIGNATURE
I~I s}(J7
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
r9
J<.rJE ~"\:HEDULE
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 $ J ~()6 crO Building Pennit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERN.UT FEE $
c3f1.6()
.50
J.I 0 ITO
(Offiee Use Only)
This Application Becomes Your Building Permit When Approved
pai~~,eY'
Date I,?--/ I~J ;)-
, Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Rect)~1() 7
B~
U
-'