HomeMy WebLinkAboutPlg Permit 02-1369
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or print and sign at bottom)
ADDRESS
\43Dlo l;t)'U"L- c+ ~S
I. Blue File I PERMIT NO aJ
2. Gold City . 0 ""\ - ("_.;,;z . 1
3_ Yellow Applicant ~ ~ )
ZONING (office use)
Iff
LEGAL DESCRIPTION (office use only)
LOT q BLOCK I ADDITION K/uo b 1-1" II 5U
PIu25.... 3U-O()q-~
(Phone)Y58 - (;J33~ 8~la'
OWNER ~ .
(Name) 0eA\+cL "'l\,l l\neJ"G
. (Address)
APPLIC~T \ f"\ . \ \ -'2 Q1 n ~_
(Name) ,--~-L:A\)''i \JW\e./~\ 1=-i\lJL.L'Ct+e.R- (Phone)l \'5 -~)OUt-(\u'lol
(Address) 5'1:~ Clh-{ 'Y,r\ PI ~-tL. \t5\-\ t-h~ct~Or\ \.~ \ 3-( D t ("
(Address) (City) (Zip Code)
(Contact Person) ,,_ ~\ ~ 0~hDb-e..R- (Phone)
APPLICANT SIGNATURE _~L\f\~~ Y\{-\{-y-,r- _ DATE' (')\ \\.'t \ ()~
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
I Dishwasher
I Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall
I Sinks CTION
I Ba REQUEST FOR INSPE NO
I W. SENT TO CONTRACTOR-S
RESPONSE - CLOSE FIL
MAY 2003
Industrial, Commerci
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
EDULE
._, .JV utlllimum
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
'-../ -
~q.,}[J
.50
lif) I aD-
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
. Paid { 0, crU
Date
/CJj /<? /27
. Rec~op9 q
By . yo/
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714