HomeMy WebLinkAboutPlg Permit 02-1413
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO
2 Gold City '0)-', J_ h 1'13
J Yellow Applicant ( ~ .~ /"'1
(Please type or print and sign at bottom)
ADDRESS
:J 7/'3
FoxTAi I
T((,4i I
ZONING (office use)
1<0-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID~5-3?S- (j3/-C)
OWNER
(Name)
tvf ,J$/VlI(,tVN
(Phone)
(Address)
APPLICANTAJ fl r.:.
(Name) ( vr 6c C-.
(Address) 10) "5 (,
-+ ;t1oorlF W A TefL
~ 99 Th ;tv(
(Phone)
p(l.,~(efo~
. (City)
7 ~ '3 "J g 9 ~). S~}...I
\5- 37 /
(Zip Code)
(Address)
(Contact Person) p IT r/(.? M;Afl."[ IJ.
APPLICANT SIGNATURE :/t; j' ~ ~
'./
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity I
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain ..., Water Softner
--'--
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks FOR INSPECTION Backflow Assembly Test
Bar Sink REQUEST TRACTOR NO Lawn Sprinkler
Water Closet (Toilet' SENT TO CON . Other
) RESPONSE - CLOSE FILE
(Phone)
76'3- .;2gr6' Oftf f-
/0:75~O2..
DATE
Quantity
Type of Fixture
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 $
8Q'30
i/i)/- .5~
(Office Use Only)
Building Official
Date
I Paid Llo / --
[)ate ~ ~_
IIJ-;:}"J- 0-
Receipt Nl/;}-q I L/
B~
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714