HomeMy WebLinkAboutPlg Permit 02-1444
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
/CJ-30-0Z-
I. Blue File PERMIT NO
2. Gold City Q ~_/i A../LA _
3 Yellow Applicant t- 7""'-cr-
(Please type or print and si~ at bottom)
ADDRESS
\c5L(0,
Sk.p ,an
ZONING (office use)
Q1 ( 00
LOT
LEGAL DESCRIPTION (office use only)
PID
'10 vu ['!~I
10' Lf (1 \ (\+ep hJ-()
1~;;~~ANT C1G'\Gtm (\\i~v
~ l1lL{C 1/YY' ct{, (t '\'>Ctfrl
,(Address)
(Contact Person) C1f': LLlu\
APPLICANT SIGNATURE )
OWNER
(Name)
. (Address)
(Address)
Quantity
BLOCK
ADDITION
'fY\ Gl1 CZsf:rv
~iv
q'0~~44 0) -y C00
(Phone)
~~
(Phone) {(~ ~- ~ql(- ~?j 01
((WV\\(G fKtL/{J
(City) (Zip Code)
(Phone)
DATE
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (1 or 2 comnartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
D"~kflow Assembly
REQUEST FOR INSPECTI kflow Assembly Test
SENT TO CONTRACTOR ON vn Sprinkler
RESPONSE _ CLOSE FILE NO ler
.. J1.,J1., ~'L-.I..I..&J~ ~__
Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum
(Office Use Only)
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit # () 2> - / +-f-tI-
39.50
.50
4-0~O(j
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
This APpli~a}i~n ~comes Your Building permit... Wh.en Approved
b J j.1Id- /6" '50 - V2-
li~lng Official Date
Paid .AO
'r . U-O
Date
La .36.U2-
Receipt No. 0
~ ?2-J'"
By "--1
C/'J'
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714