HomeMy WebLinkAboutPlg Permit 02-1520
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
55/2.
~. ~~ ~:;y I PERMIT NO'OJ- /5 '""\ .l
3. Yellow Applicant , (iI' ~
VJood'5icle... R oa-d :Sol.(~-e.A.S-t-
ZONING (office use)
RI
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
-;j-; 3 (.
PID~S"- 3'-0/3-
OWNER 1:;? _ 1"\ U
(Name)~('Ka.. J l..L.=-D.
,
(Address) 5'5"/2. WOcdt)/~cJ~ /(oa.d ~_b.
(Phone) (i52) 117-3G:,07
APPLIC~ b\ =:i2' . L
(Name) of ~ \iUAN\.P\~(1
(Address) 210$ bJM"fi ~/J Itve. ~a.
(Address)
(phone)
~lt~
((PlZ) 8Z7-t{03"3
5""537Z
(Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
DATE
/1//5/02..
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher I Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laur . 'T"'. -- /1 ~-., ,..ntnn"rtmemt sink Sewage Ejector
Shm Backflow Assembly
Sink REQUEST FOR INSPECTION Backflow Assembly Test
Bar SENT TO HOMEOWNER 2/03. Lawn Sprinkler
Wat NO RESPONSE. CLOSE FILE Other
FEE ScHEDULE
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 $
31. 5"0
.50
~() .t70
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
n
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714