HomeMy WebLinkAboutPlg Permit 02-1412
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO
2. Gold City .:;."} ) _ 1'1.111_'
3_ Yellow Applicant (/::;;J... -/1 c;:r-
(Please type or print and sign at bottom)
ADDRESS
r:;x ''''1',
ZONING (office use)
K2
.$' jq 7
TRAi' \
LOT
LEGAL DESCRIPTION (office use only)
ADDITION
OWNER
(Name)
(Address)
BLOCK
PIDc25"-3S5 - OO~,'-C
wE N$ /l1 ff,JtJ
(Phone)
APPLICANT AA ILc
(Name) /vrOo r
(Contact Person) O/hlt: Moo(2t!
APPLICANTSIGNA;URE -?A() ~ C2
/'
APPLICANT PLEASE 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
W t CI t (T '1 REQUEST FOR INSPECTION
a er ose 01 ( SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
(Address)
Quantity
/037'
-f:-- /100 f2 G' i.Jlrn/fl
~q9.T^ kVt--
(Address)
(Phone) I 6 "5 - OJ ?J'~f ~:2.S-;< I
f (Z\ -rJCtrfa"J S;S; 37/
(City) (Zip Code)
(Phone)
7b 3 - ;) ~ 6 '/) I '-I )
DATE / {} - 023 -o~
i
Type of Fixture
a-
Rough-ins
I Water Heater
I Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
Industrial, Commercial & Multi-family I
:idential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3q-5[)
.50
-I-II),
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid l.( 6 ; -
Date/\, '":2 _ 1
) v- c? '/ C/
Rect7 ~o9 I L{
, BYQG
V
24 bour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714