HomeMy WebLinkAboutPlg Permit 02-1145
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File
2 Gold City
J Yellow Applicant
PERMIT NO.
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(Please type or print and sign at bottom)
ADDRESS
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ZONING (omce use)
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LEGAL DESCRIPTION (office use only)
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OWNER
(Name)
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(Phone)
(Address)
APPLICANT AI! AA
(Name) / Ji ,()o!f {i /'/ tJ d ff t1./A-'rJ::7L
(Address) It) ]-~b 2.91'7J. Ave
(Address)
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~PLICANT PLEASE COMPLETE BELOW
Type of Fixture I Quantity
Bath Tub with or without shower I
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sin\.
Shower Stall T FOR INSPECTION
Sinks REQUES CONTRACTOR. NO
Bar Sink SENT TO _ CLOSE FILE
Water Closet (Toilet) RESPONSE
(Contact Person)
j/LcA-t/''1tJ~6one) ?G'Y. 56"'1. ..2. } 2 /
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(City) (Zip Code)
(Phone) 7(, '5-;2 cPC' - (.; 1'1$-
DATE Cl- J 1- 0:2..
APPLICANT SIGNATURE
Quantity
Type of Fixture
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Rough-ins
Water Heater
Water Softner
St<>"d Pipe (Washing Machine)
1ge Ejector
flow Assembly
low Assembly Test
Sprinkler
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 $
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
r I
es Y o'ur Building pe~it Xen Approved Paid A.
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1, If 07- Datel I
BUild~C~'al (I nlite flu /OZ,
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our notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
$
$
$
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_ .50
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Receipt N4 ~3:}
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