HomeMy WebLinkAboutPlg Permit 02-1155
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO -
2 Gold City "0'" -11 e-t:;"
3 Yellow Applicant (7"" J
( ?12.)
(Please type or print and sign at bottom)
ADDRESS
.IUOI5 No"+f1wood gJ
ZRNtsnSeJ
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION vfI m7/A !; /J1d.
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PIDdS- Jt} I" () g ~.- 0
~V:~R\JOYJ GII'~t J "John
(Address) 1 U D I C; NDV-rHV\Jood ~,d
APPLICANT
(Name)
(Address)
(Phone) 9Q-LJ4J - LlSq 2.
CULLIGAN WATER CONDITIONING
oo""u CULLIGAN WAY
MINNETONKA, MN 55345
(AdM~~) 933-7200
(Phone)
(City)
(Zip Code)
(Phone)
(Contact Person)
APPLICANTSIGNATURE-ffi ~V\~(~
Quantity
DATE
q; !~~ / D2-
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (1 c "._1-
Shower Stall REQUEST FOR INSPECTION
Sinks SENT TO CONTRACTOR. NO
B S. k RESPONSE - CLOSE FILE
arm MA
Water Closet (To Y 2003
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
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
(Office Use Only)
Estimated Cost $ 2D D " tJO
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ 3Q.SO
$ .50
$ 40. OD
Building Official
Date
paidLj.o,__
DatZf -/3 - ;J..-.
Rece2l~~~L./
BY~
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714