HomeMy WebLinkAboutPlg Permit 02-1225
1. Blue File
2 Gold City
3 _ Yel10w Applicant
Date Rec'd
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PERMIT NO. OytZrz6
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ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER / ~_' ~'
(Name) ~ 't:;-.rJ ) 1/1 A-r:
(Phone)
(Address)
~~:~~~AN~;Z10o iLc ~ ilI"J{J ([E IJJ/f!PiL (Phone) /6 /?. /;:Yi-;l )"2 I
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(Address) Ie j,-:>f & ,;2- 9' '1 13 Ad- j)(l/A/[rIP-' ,-5"7 7/
(Address) (City) (Zip Code)
(ContactPcrson) ./};h/C 1f't~f . (Phone) 76 j;.r6 - ()/ $I ')-
APPLICANT SIGNATURE 3?f: ? c.~d' DATE Ci'r )""7(/.- (;7'Z
- - - - -
/ / / /
~PPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall
I Sinks
Bar Sink
Water Closet (Toilet)
Quantity
Type of Fixture
..::z.
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
~ewage Ejector
ackflow Assembly
ackflow Assembly Test
'lwn Sprinkler
ther
REQUEST FOR INSPECTION
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
.. J!,J!, :SLH.t:D ULE
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 # () Z -/l.- l- S
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
J9,SlJ
.50
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(Office Use Only)
This APP"1tj;jres You, BUi':;;tt W:~:;:roVed
Buihling Official bate
. paid4-o . uV
Date
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. Recei~30/0
By A.
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24 hour notice for all inspections (952) 447-9850, fax (952) 4474245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714