HomeMy WebLinkAboutPlg Permit 02-1371
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I 3 -1 J
1. Blue File PERMIT NO _
2. Gold City . 0 1_/2':'1
3. Yellow Applicant '^ J. I.
(Please type or print and sign at bottom)
ADDRESS
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ZONING (office use)
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LEGAL DESCRIPTION (office use only)
OWNER~
(Name) <.J)\cC\.-\...~ ne r-'
LOT/3BLOCK I ADDITION ft!llXJh ~
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(Phone) CxfJO - d?J "b-d.~VU
(Address)
APPLICAW r )
(Name) ~~+. \. '^ "'\\L \())\.e~ b{\j(")l 1 )O+e~ (Phone) "--1 \,5- '?:>~ o~'X1 ~ tOI
(Address) t5,-~ (\.+t,j \2-[j A. ~-t-e- \ 5L\ \-ku=l~J\ lu I 91 D 1 Lo
(Add~ess) (City) (Zip Code)
(Contact Perso~, \'f\") CJC\h.lt::i::.SC (Phone)
APPLICANT SIGNATURE \t \\Y\ ~~ ~r\ ~~'L
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DATE
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Quantity
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 comoartment "int,..
IlliQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
MAY 2003
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
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 $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
c:Jq, ~m_
.50
/f-j) , I51l
(Office Use Only)
Building Official
paidZf' OU Receipt No. C. C
0, - Lj;:). cr ~I (
Date '("'; Ii:\--. By ~
Date J () -hs - (/ (/ 1/ -
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
This Application Becomes Your Building Permit When Approved