HomeMy WebLinkAboutPlg Permit 02-1495
I
/
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3. Yellow Applicant
PERMIT NOt'o?_ / '-!tJs."
....
( 612--)
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(Please type or print and sign at bottom)
ADDRESS
\L{3LP5 ,~ PJlud.
ZONING (office use)
R~
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LEGAL DESCRIPTION (office use only)
LOTI; BLOCKd ADDITION ~ U~
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PIDra.!) - 3PL/-0f9 9-0
(Phonelgt:g.)YgU -CQUf1
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OWNER .^ & ^' /l f'\. n
(Name)_("")t }C.-t~ I .0JCAn
(Address) . f:>1 vel N l^I
APPLICANT
(Name)
(Address)
CULLIGAN WATER CONDITIONING
ou",0 CUtLlGAN Vv'A' "
MINNETONKA, MN 55345
(AddresWb~) ~;;s~. {~UU
(Phone)
(City)
(Zip Code)
(Contact Person) ...... fil _ (Phone)
APPLICANTSIGNATURE~(~j_;e1\L\ DATE -' 0131/02-
APPLICANT PLEASE COMPLETE BELOW
Quantity
Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
La' --' -. .
La! REQUEST FOR INSPECTION
Shl SENT TO CONTRACTOR. NO
Sit RESPONSE - CLOSE FILE
BaJ MAY 2003
W~____
Quantity
Type of Fixture
... ~---7
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
14.1!..ESCHEDULE
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 $ 200.. 00 Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ '" -'111 . 5b
$ - .50
$ _ 40 to QO
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid '-/LJ., o-V
Date I J - J ti-OCJ....
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Recell~~ ~
B~'
24 hour notice for ail inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave" S.E., Prior Lake, MN 55372-1714