HomeMy WebLinkAboutPlg Permit 02-1363
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quautity
Bath Tub with or without shower
I Dishwasher
I Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (1 or 2 compartment sink
Shower St!>ll FOR INSPECTION
Sinks REQUEST CONTRACTOR. NO
Bar Sink SENT TO E CLOSE FlLE
Water CIc RESPONS -
MAY 2003
(Please type or print and sign at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
OWNER-\) .
(Name) Y"\C,,- nf\\ \ e
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LOTI~ BLOCK:J-. ADDITION
(Address)
APPLICAN.T T \
(Name) (--n-.
(Address) S-l :.7)
APPLICANT SIGNATURE
Quantity
I. Blue File PERMIT NO j
2. Gold City '()'j ~'- /.3. j .
). Yellow Applicant ~ ~ li?
ZONING (office use)
~5 12/
;) !LJeL PID;(S-37.J.- 058-4
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(City)
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(Zip Code)
(Phone)
DATE
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Type of Fixture
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Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
}'EE 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 $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
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.50
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Paid LJ.
-10. -
Date .
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S,E., Prior Lake, MN 55372-1714