HomeMy WebLinkAboutPlg Permit 02-1336
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File I PERMIT NO ~
2 Gold City '0/'] ') -/'3:=>
3 Yellow Applicant C/c:T V
(Please type or print and sign at bottom)
ADDRESS
3S-CJ1 FofiA,'/ Tfl/jI'/
~wJ
ZONING (office use)
72--:1..
LEGAL DESCRIPTION (office use only)
LOT 1 BLOCK I ADDITION Iv VnO'7iLd/)(/J'J ,~/V'J J4:c/J~ PIu;(S- 315- ()O 7 -C)
OWNER ...:: ~ Al
(Name)~'CtV JM~
(Phone)
(Address)
APPLICAN1AA 11 Z-
(Name) / r I OO/C.-{,
,
(Address) 10 3 3~
""l) )10 bIlE GJltTffL -llltitfNc,J t (Phone) 2.f. J .. '5 EC) - ;2I""";< (
,) 99 !]:. A iK Nfl 1(21 ;.<<f1;~ t;:s3 7 /
(Address) (City) (Zip Code)
(Contact Person) p/tVC l1o~!l{; (Phone) '76 3 _. 2tb -01 'IS.-
APPLICANT SIGNATURE ~ 914 DATE /0 - / / - CI::z.,
/ /
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 cor
Shower Stall REQUEST FOR INSPECTION
Sinks SENT TO CONTRACTOR. NO
Bar Sink . RESPONSE - CLOSE FILE
Water Closet (TOIlet)
Quantity
Type of Fixture
-
.:..t-
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
~ 'age Ejector
kflow Assembly
kflow 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 $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
39S-u
.50
L-/O_-
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid /j,tJr
Date ! tJ - / I r if--
Ry'~/}
By r----
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714