HomeMy WebLinkAboutPlg Permit 02-1366
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I, Blue File I PERMIT NO
2, Gold City 0/:,' ) l~ /' "1., i" I
J Yellow Applicant {/C7' J"-'?tO
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
\ lolt~1 (] +\V-L t\ DLlu Y-D A \Ye~- SF- ,j<.:75CJ
LEGAL DESCRIPTION (office use only)
LOT ,3 BLOCK 3 ADDITION
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Gs-j-
PID;25" J / j 3~ Qj-O- )
OWNER\.. r-. " ' I '
(Name) ('-1 \.\ \hr~ he~\ ~lDRt=
(Phone) C\~d -'Ora (c- '3D \8
(Address)
~~~;~~A~ . C' :~C\ \ \j \\~ \,\e_ll 1=.-C'-/J 1.1 U+e-&hone) '\ \ 5 - 3?U '- 8' LD~ I
(Address) ,~l~ 0;1-lj ~d R- 'f*e~ lC5l\ fut0l.(~ WI
(Adliress) (City)
(Contact Person) '---~\ m ~rv h. Dkl e R-- (Phone)
APPLICANT SIGNATURE ~ t 'JrY\'~~\i\OOt /K=-.
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture I Quantity
Bath Tub with or without shower I
Dishwasher I
Floor Drain I
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall EST FOR INSPECTION
Sinks REQU 0 CONTRACTOR. NO
Bar Sink SENT T E CLOSE FlLE
Water Closet RESPONS -
MAY 2003
~'9--1 D It 0
(Zip Code)
DATE
ID\\[))b-d-
Quantity
Type of Fixture
\
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
l'J!.,E 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 $
04lSJ
.50
L-l0 . fJl)
(Office Use Only)
Building Official
Date
, Paid lj{) ( ___
Date
/ C> - /Y-o:?--.
, Recelj!f99
By cr.-/
u
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