HomeMy WebLinkAboutPlg Permit 02-1477
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS I J I/"" 12 _ -.--: \
/,2105' V ht\.dy' oea.c-,- I \tU,
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LEGAL DESCRIPTION (office use only)
LOT
ADDITION
BLOCK
OWNER
(Name)
Eclt..J;Y) 'Oa./~'Tl
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(Phone)
(Address)
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(Address) f)t;'IJ!J ~j../~7rO
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(Phone)
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(City)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
DATE
Date Rec'd
PERMIT NO. O~-IL//t
ZRisG/iffice use)
PID ;;S -/J 1/5' --IJ() 3-<)
(Cf~2) L/'-/5 - 6'1 tic
~~ij"or
(Zip Code)
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity I Type of Fixture
Bath Tub with or without shower I Rough-ins
Dishwasher I Water Heater
Floor Drain I Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundrv Tnw (1 ,,~"'I - ~ Sewage Ejector
~ PECTION Backflow Assembly
S REQUEST FOR IN~ER 2/03. Backflow Assembly Test
B SENT TO ROMEO E FILE Lawn Sprinkler
" NO RESPONSE. CLOS Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Quantity
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ i07) pa2.
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3'1 . 50
.50
'10 . 00
(Office Use Only)
Building Official
Paid 2/0(00
Date ~
Date _, -
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
This Application Becomes Your Building Permit When Approved
Receip~q 7 ;r---'
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