HomeMy WebLinkAboutPlg Permit 02-1367
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO
2. Gold City . /f""J.. . . ) _ / 3 J :#7
3_ Yellow Applicant L/:7- (.?I
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only)
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BLOCK
ADDITION
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(6/Cf PID d>5-' 377- 037'-0
(Phone) ~.Sd ~ ~dLP-lL~3(1
OWNER \.
(Name) "- \ \Y\
(Address)
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(Address) ,5 "\ -8 c: ~ ~\ V--o\ ~ CJ\€- \ DL\ m A r\l~f\ \.lJ \
(Address) (City)
(Contact Person) "- \ \ ry-----., c;:-:{\ _ hC\ bl ~ (Phone)
APPLICANT SIGNATURE, ~ ,)" c.01wil)l R . DATE iCl \ \ t, \ tr::l
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quautity I
Bath Tub with or without shower I Rough-ins
Dishwasher I Water Heater
Floor DrainJ Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray RE - -~..,"rtment sink Sewage Ejector
Shower Stall SE:JUEST paR INSPECT Backflow Assembly
Sinks RE T TO CONTRACTO ION Backflow Assembly Test
Bar Sink M SPONSE - CLOSE PI R. NO Lawn Sprinkler
Water Close A Y 2003 LE Other
Y-~DJ L?
(Zip Code)
Quantity
Type of Fixture
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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 ,:50
J-riJ . (1)
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
I PaiL
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Date
Date /0/ /fi'Jr-
24 hour notice for all inspections (952) 447-9850, fax (9~ 44~245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
, Rece~~?99
By
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