HomeMy WebLinkAboutPlg Permit 02-1337
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or print and sign at bottom)
ADDRESS
3gC;S- 12E&4J
I. Blue File PERMIT NO
2. Gold City . ~ .} -/ -:J'3 /'}
]. Yellow Applicant ~ -J . /
PitS 5
ZONING (office use)
/2A
LEGAL DESCRIPTION (office use only)
LOTII BLOCK d-' ADDITION K-x-wQ (~r
u
PIDc25--3t~-()d-7 -0
OWNER n- . _ J
(Name) 0c r-l5/L1AII/ /V
(Phone)
(Address)
APPLICANT SIGNATURE
~~;~~ANTyY)ooflE r NotJ1I.C tJl}-TfjL 1lt1'#7f/J1(Phone) 76 J, jr,-;2S-dl I
(Address) J 033' .;1. ~ c; r:A. A tit. ;<4, P'A 'ivct.-fo~ ~)5 7/
(Address) (City) (Zip Code)
(Contact Person) ()1J1I[ (J1/)()tZ.( (Phone) 761-;; 16 - (It Y j
fftI}~1I DATE ~(}"I/-o~
/{PPLIC{N;PLEA~E COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
I Floor Drain
I Lavatory (Bathroom Sink' I
I Laundry Tray (1 or 2 com
I Shower Stall REQUEST FOR INSPECTION
I Sinks SENT TO CONTRACTOR. NO
I Bar Sink RESPONSE - CLOSE FILE
I Water Closet (Toilet)
Quantity
Type of Fixture
.
::L
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
1ge Ejector
;flow Assembly
dlow Assembly Test
n Sprinkler
~r
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 $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
39 :::>--0
, ,)1' ,50
~v, ,
$
$
$
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid LirJ, - R~~cf"7
Da/O'/I_d--,BY ~
U
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave" S.E., Prior Lake, MN 55372-1714