HomeMy WebLinkAboutPlg Permit 02-1219
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Contact Person)
,APPLICANTSIGNATURE O~-:;;?~ ---.--
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
(Please type or print and sign at bottom)
ADDRESS (;,21 ( t)ow:L VI $-bre-e.--l
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LEGAL DESCRIPTION (office use only) atJ
LOT l.f BLOCK I ADDITION 1J)iJi;.(L.frlr!- a
OWNER f\ " .~ .,
(Name) '''\l..VVO\'''''J. ya:xr.c.K
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(Address) (,,2/1 '1;~ iY) Si - N. ~ .
APPLICANT l \. .~ L
(Name) NO rb\UVV\ r\ \UN\P\:\j
(Address) 2C}OS- ~tI./r.{;e/d Ave. So,
(Address)
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Quantity
Sh{'\u.r~'" C'......... 11
REQUEST FOR INSPECTION
SENT TO HOMEOWNER 2/03.
NO RESPONSE. CLOSE FILE
I. Blue File
2. Gold City
3 _ Yellow Applicant
PERMITNO'D~ _ I;;)/~
ZONING (office use)
12 ;)-SQ
PID~f /~ oD -OCtl1)
(Phone)
(~S2) ;..J'fO -/ZCjJ1
(Phone)
(It,12) 227- Lj 033
551.j() 8
(Zip Code)
~l'\r\ s
(City)
(Phone)
DATE
9//3/~2.
Type of Fixture
J
J
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
J:' ~E 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 $ tsx:n>!!?
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
3q.STJ
.50
&(() . /)0
paid~lj() ,____ ReceiP/J;:Wf:!
DatZi'_ ~ 7-0J-)3Y · ~
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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