HomeMy WebLinkAboutPlg Permit 02-1368
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO ~
2. Gold City ./) ::1 - J 31 _
3 Yellow Applicant U~ \P
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT {O BLOCK ~. ADDITION
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PIDcX!7--37d.- 05S-"D
OWNER ~
(Name) ("'_ \)f)\ l.~ \() ~
. (Address)
(Phone) \. n l d ,'i</,) 7=> - \~u;LJ Lj
1~;;~~A~, r A () l'f \) ()J \.e/LI to lJtDQ1e~Phone) L \ 5 / 38lo - 2sL ~I
(Address) \~l~ C::k I ~ ~ ~ \"51-\ .ttL\ti~ tul.5LlolLP
(Address) . (City) (Zip Code)
(Contact Person) '--.\ \' n----- Q QJ\ (jheJC (Phone)
APPLICANT SIGNATURE ~<\fY'\ ",c-'-!i'\t\~ ~~
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (I or 2 compartment sink I
S?ower Sta' REQUEST FOR INSPECTION
Smks. SENT TO CONTRACTOR. NO
Bar Smk RESPONSE _ CLOSE FILE
Water Close MAY 2003
DATE
tD' 10 ll)~
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
I Backflow Assembly
I Backflow Assembly Test
I Lawn Sprinkler
I Other
l'EE SL:H~DULE
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 $
;?)q I 50
.50
LID · DlL
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
I Paid <f{)./ _
Date
10- /R- d-
. Ret/~~'9 cr
By ~
f
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714