HomeMy WebLinkAboutPlg Permit 02-1160
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~. ~~~ ~~~y PERMIT NO. /JI _ JI'D
3 Yellow Applicant (,1 ~ t:J
(Please type or print and sign at bottom)
ADDRESS
L{-1lf3 minnf31ttL Gtree-t D.e.
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PInJ.5-00/- O~-2)
OWNER
(N ame)
Arnold , M'S~
4qb3 mtilnesota
(Phone) f.!i!.1~) Lf!D - 54/3
(Address)
0treef
Q.E.
~~;;~~ANT Nort;lf5m PLum binCJ
J
(Address) 2QOS tJarf1fld /lY, (D.
(Address)
(Contact Person) ~ff Nor b ll5YY1
APPLICANT SIGNATURE ~
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(Phone)
((P/~ g1--7~4D33
55LfOg
(Zip Code)
([ell) <?Z7- 4033
DATE q / 8" /O?--
(Phone)
rnp/S
(City)
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Sewage Ejector
REQUEST FOR INSPECTION Backflow Assembly
SENT TO HOMEOWNER 2/03. Backflow Assembly Test
NO RESPONSE. CLOSE FILE Lawn Sprinkler
Other
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 $
ifD() . cD
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
6{.te
.50
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(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid ~
L/O I --
Date C{- /3-0 d-
Rec~~~
BY~
V
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714