HomeMy WebLinkAboutPlg Permit 02-1370
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO ') t1
2_ Gold City . /\1 ,-. ( 7 I 0
3. Yellow Applicant L/c7-J -
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only) ,
LOT rr BLOCK ~ ADDITION ~/o4I..xVYt/ h
OWNER.-r-
(Name) I n e~e~
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(Phone) OL~a- W~/-l3l-1
(Address)
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(Address) \~\~~ 0~ \ ~1-\j n ~1e_j \t)l1 t\l\Ci~ lD \
(Addr~ss) (City)
(ContactPe.-son)\. \ ~ ~rW~:\l1L (Phone)
APPLICANT SIGNATURE,:..')\ \'\'\ ~\hD\cj\i2---, DATE \ b\ t b\ C~~-----
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 compartment sink
Shower Stall
Sinks
~1l~~UEST FOR INSPECTIO~O
SENT TO CONTRACTOR.
RESPONSE - CLOSE FlLE
Industrial, Commer, MAY 2003
~)ll D \ l 0
(Zip Code)
Quantity
Type of Fixture
\
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
IEDULE
nimum
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
~~
.50
4T'n ()C)
(Office Use Only)
Building Official
Date
. Paid q() I ./"
Date
'Io--/~""()'J--
Receipt No. qq
if:+?
By
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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