HomeMy WebLinkAboutPlg Permit 02-1116
CITY OF PRIOR LAKE PLUMBING PERMIT
Date R-ec'd
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APPLICANT A A A..
(Name) /Y/ /)017r ~ /Vf/) Dflc t.JIrTf/(
(Address) /()? 3G ;2 Cjq 1?)/J vt
(Address)
(Contact Person) ~;1{{) 0 if:,
(.~ PLlCANTSIGNATURE ~m hn
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (J or 2 c()mn.,ri~~-~ . , INSPECTION
Shower Stall REQUEST FORTRACTOR. NO
Sinks SENT TO CON ILE
Bar Sink RESPONSE - CLOSE F
Water Closet (Toilet MAY 2003
(Please type or print and sign at bottom)
ADDRESS
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G / y r-I t./ ,1 fcr?
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
~ t' /" SJ17:t,;- /
(Address)
Quantity
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum
Estimated Cost $
PLUMBING PERMIT FEE
STATE SURCHARGE
I
I TOT ALl: rIT FEE
{,-tOffice lJse On!Y1.. " /
( )hi' A~P';tfi.i i~i.~~...g1e5'"Y-out Bu ilding./:.e~m.' it hen Approved
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f( . .! ./".~ " ," 1/ /l....... l,.,..o-
Building Official ------.) Date
1. Blue File I PERMIT NO
2 Gold City . .t;. -; _ ..//1 i I..
J Yellow Applicant __ c., I \.;;1
ZONING (office use)
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PID
(Phone)
(Phone) 7 b ? -
f}t t "fJc[fD,N
(City)
(Phone)
313'1 ~.:1~.;2 )
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(Zip Code)
/05 - ;2r6 - O/V;-
DATE q- 9'..- o?
Type of Fixture
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Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
Residential, New One & Two-Family $99.50
Residential. Additions & Alterations $39.50
Building Permit #
$ ;;q - ~()
$ .50
$ Lto
Paid /} a- -'
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Receipt Not.,'>._ ".
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By
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714