HomeMy WebLinkAboutPlg Permit 02-1115
CITY OF PRIOR LAKE PLUMBING PERMIT
AnrV.1 .{/~/ /01.137,
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(Please type or print and sign at bottom)
ADDRESS
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LOT
LEGAL DESCRIPTION (office use only)
BLOCK
ADDITION
APPLICANT!t1 ./fop ___ AA "/) r L,~
(Name) . aJ,Lt. 0 /'(Cd/I:..C "Vi /'-'(--
(Address) /0 5'30 ~ 40; TJ.. ArE.
(Address)
(Contact Person) rJ#E /!1 0 dZC
APPLICANT SIGNATURE ~ r:; c1; Ii
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/
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Oi'
rh CLOSED WITH SF
L:, BUILDING PERMIT
Sh(
Sin.__
Bar Sink
Water Closet (Toilet)
OWNER
(Name)
(Address)
Quantity
WG ,J 5 l'l.ttrv,,J
Date Rec'd
9,- 9roZ--
1. Blue File
2 Gold City
3 Yellow Applicant
PERMIT NO. tJz-I//5
ZONING (office use)
PID
(Phone)
(Phone) 7 0 .~ ,- '5 t,) - 25;2 /
ffl/IfICf/o) '-)5-"? 7/
(City) (Zip Code)
70 '3.'.J.! t-~ - 0/ <-/\'
DATE 9- 7.~ ()..2-
(Phone)
Type of Fixture
,;J-
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 $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL iEjIT FEE
o r BnHd;ng Perm; wfen Approved
) C{ { ~f I O"~
~ llOite
(Office Use Only)
This A~I . t~
\ .
I
Building O~I
Paid
. J +D. ~
Date d
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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
Building Permit #
$
$
$
- a-O
;'1.')
.50
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Receipt No. _
4 30Z.~
By ~~A