HomeMy WebLinkAboutPlg Permit 02-1364
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or print and sign at bottom)
ADDRESS
I. Blue File PERMIT NO I
2 Gold City './i.~ J - -/3/' J
3 Yellow Applicant ~ lJ?'-j
,
ZONING (office use)
\\oL\ \\
\\\ CLnr\f\ 1\ -hV'-L 3'6
(2)
LEGAL DESCRIPTION (office use only)
LOT~ BLOC0 ADDITION ~~ ~ Jf.Al PID,JS-O!b-OJ.4-0
~~e~R ~LO() 1\ ~ () J\ \~n (Phone) C\ CSd -qLII-5q~;)
(Address)
~;~~fA~--,\-. (\1\ l) lV
(Address),~l ~ (l-:;h I ~rl
(Ad~ress)
(Contact Person) ~l ~ f:::>c'l10DfJL
~ \ m ~~I\~bo L
.-/
\kJttle~1 ~0 OlUl+e-fuhone) l t 5- 3~ -?;Low,
A ~ \CSLJ m~cie:L)n Wl 9-~Dtw
(City) (Zip Code)
(Phone)
APPLICANT SIGNATURE
DATE
\ 1)\ t'tJ \ tY"d-
--. _.
Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry ~ '. - - '") ""mnartment sink
Shower ~ :iQUEST FOR INSPECTION
Sinks NT TO CONTRACTOR
Bar Sink RESPONSE - CLOSE FILE No
Water C MAY 2003
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......... _
JLE
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 $
,3q,~
.50
4D · Ol,L
(Office Use Only)
Building Official
Date
. Paid 1;0 --
Date
ILJ - /g- d-
. Recei~f9 cr
By
~
tJ
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