HomeMy WebLinkAboutPlg Permit 02-1154
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
-L73IJ3 /I1///d~r/Jd~ C-/rd~ S"E
LEGAL DESCRIPTION (office use only)
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LOT ilBLOC~ ADDITION I~f..rr,~ 0L- ~
OWNER
(Name)
(Address)
APPLICANT
(N ame)
(Address)
Mt.4SS'O I JaJtJr7
/73~?; W;'/afer/)esr
&'rC/G
CULLI~~N WATER CONDITION1N~
OU;jU l;ULLlGAN WAY
MINNETONKA. MN 55345
(~21s~33-7200
(Contact Person)
APPLICANT SIGNATURE -/.h,tjziJIG <:.. r-J.evt/llJ
Quantity
I. Blue File
2 Gold City
] Yellow Applicant
PERMIT NO. ()J..- /I.s-~/
(a72)
ZONING (office use)
Rd--
PI~~~5 -Pi? 1.;(2 I Lf-{)
(Phone) (rSL) 1t/7 - -33/3
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(Phone)
(City)
(Zip Code)
(Phone)
DATE -.B /2B./(}2
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain /
Lavatory (Bathroom ~ REQUEST
Laundry Tray (l or 2 SENT TO FOR INSPECTION
Shower Stall RESPON CONTRACTOR N
S' k SE CL . 0
In s MA Y 20 - OSE FILE
Bar Sink 03
Water Closet (Toilet)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
3ackflow 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
Estimated Cost $ -.2- If P'. tl a
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~S"o
. ,50
:Lt). dO
paidj J
tlO-
Date tj,- /~ __ Q..
Rece:;; J-~~1J
B~'
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714