HomeMy WebLinkAboutPlg Permit 02-1365
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3, Yellow Applicant
PERMIT NO. Ddv -/8105--
(Please type or print and sign at bottom)
ADDRESS
35DY +~ t\'i-m_ ~ \ ,--\ Q L
ZONING (office use)
l~ I
LEGAL DESCRIPTION (office use only)
LOT (iJ BLOCK ;r ADDITION tv #.,{YJ'J1(.{/U-1V
/51-
PID ,-25- 371>~()ILf-()
OWNER Q \ ...-----' I
(Name) '- It-e'f1r"\p f\ \~C pu_n \p ~)
(Phone) 3 \ -1- L l r3- LI , Lo Lf)
(Address)
APPLICA~U\ ".
(Name) '--- --:n- '
(Address) ,,~L ~
QA D \ Y \)0 \. \e \..1 ffl6ltU+-e12.(Phone) ll5 - ~C '.- ?iQ Lf7
Q::h I'~~ A 0te.- \lSLl ttLlci~n I' 0\ :~tb tLo
(Addres~) (City) (Zip Code)
(Contact Person) ~\..Xy\ ~-t\ ~e R,. (Phone)
APPLICANT SIGNATURE J \- rr. $~Jr1l'\"DLR--
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
DATE
16 \ It 10~
Quantity
Type of Fixture
,
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
Lavr~----' /n_~1..____ C':~1,\
Lau REQUEST FOR INSPECTION
Sho SENT TO CONTRACTOR. NO
Sin] RESPONSE - CLOSE FILE
Bar MAY 2003
Wa
FEE 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 $
?Jq.5D
_ .50
L~ 1') . ()T)
(Office Use Only)
Building Official
Date
. pai~ 0."--
Date
/0/ 1!6'-~
. Rec~~M7
BY~
II
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