HomeMy WebLinkAboutPlg Permit 02-1422
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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I, Blue File
2 Gold City
3. Yellow Applicant
PERMIT NOOZ-lt..fZzJ-
(Please type or print and sign at bottom)
ADDRESS
334'-1 Glf,Jw~
ZQNING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
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(Phone)
(Address)
APPLICANT Q
(Name) MlJoflE +- /1oct(;€ C-JltfffL (Phone) 7 (; 3 -,) f7 - 2f;L/
(Address) 10 3 3 fc ~ Cf 9 'E Atlf 1(2(('/ c r.J-e,.; s~ 5 7 (
AAddress) (City) (Zip Code)
(j,tr/I.f f1 OiJrLC (Phone) 76 "3 -- ~;j'6 - (] I Vr--
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~hLICA~T P~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
Bar Sink
Water elf
REQUEST FOR INSPECTION
SENT TO CONTRACTOR NO
Industrial, Commercial & M RESPONSE - CLOSE FILE
(Contact Person)
APPLICANT SIGNATURE
Quantity
Type of Fixture
~
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
:"'E
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
_ ,ding Permit # (J2-- /t.f? L---
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
77. !''U
,50
4"- ~'-6
(Office Use Only)
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
Paid kO. cfI.) Receipt ~ tf-l- {,J
Dati 6. L- 4-' _ d"L-. By .,f'
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This Application Becomes Your Building Permit When Approved
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Buildmg Official Date