HomeMy WebLinkAboutPlg Permit 02-1372
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
~. ~~~ ~i~y I PERMIT NO. O.).-(J..1~
3. Yellow Applicant , J g
\
ZONING (office use)
'---\-izQ. \ K I
LEGAL DESCRIPTION (office use only)
LOT CJBLOCK I-I ADDITION
OWNER ~ '
(N ame) "'- \ 1'1', ()f\
OheJl\ ~ QheJL-~' \
(Address)
APPLICANT \ (\ \r
(Name) C1t. \. ~'\ \'J \'/. \\.\.\ ~el t 'EC\ClliX\e.R.
(Address) ~ -0 0:h I ftc\ A tJte l CSL\
(Add~ss)
(ContactPerson)~\- (y, 00 h~bJ(-
APPLICANT SIGNATUR~\f\ g~"~L
PID? ~ 37Gr () i.J 5-
(Phone) J 0 \ d-~3 q - rg3Y J
(Phone) l \5 - 6?U - % Q lol
t-\Ll(i~~ \ D \ 51-1 D t L
(City) (Zip Code)
(Phone)
DATE
bd-
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Ploor Drain , Water Softner
REQUEST FOR INSPECTION Stand Pipe (Washing Machine)
SENT TO CONTRACTOR. NO sink Sewage Ejector
RESPONSE - CLOSE FILE Backflow Assembly
MA Y 2003 Backflow Assembly Test
I Water Closet (TOilet) Lawn Sprinkler
Other
FEE SCHEDULE
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 $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Building Permit #
$
$
$
{~q .50
Lf dO
b,D
q
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714