HomeMy WebLinkAboutPlg Permit 02-1127
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
~. ~~~ ~:~y PERMIT NO.1) )- I" "1
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(Please type or print and sign at bottom)
ADDRESS
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ZONING (office use)
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OWNER
(Name)
(Phone)L4.~ )LfLl5- ZOo9-
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. (Address) - J if
~;~~fANT NCorOU2m PLumbinJ (phone) (UI2) n7AfD~3
(Address) ~qOJ tJarfJ eld /1Y,','v. ' rYJ nls. tJ[jL/O%
(Address) '~y) - . (Zip Code)
(ContactPerson)\. If{f Norl?l DYn. (Phone) ({{J12) oJ7 rLfO -? ~
APPLICANTSIGNATUFJE~ DATE 0131 IOd.
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavat<
Laund REQUEST FOR INSPECTION
Show( SENT TO HOMEOWNER. NO
Sinks RESPONSE - CLOSE FILE
Bar Si 4/2003
Water vlU""" \. UH"",
Quantity
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
Estimated Cost $
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Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
\-?f1. VI2
.50
40. ~
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid
Receipt No. lY':l..- ~
1./ (J - t/'J-d C7 C7 "'
Date By
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Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714