HomeMy WebLinkAboutPlg Permit 02-1093
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory /
Laundry ~ REQUEST FOR INSPECTION
Shower S SENT TO CONTRACTOR N
Sinks. RESPONSE - CLOSE FILE 0
Bar Smk
Water Closet (iollel)
(Please type or print and sign at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT q BLOCK d... ADDITION
OWNER
(Name)
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(Address)
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APPLICANT
(N ame)
(Address)
(Address)
(Contact Pe",on) ~trJj
APPLICANT SIGNATURE
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Quantity
107'\3
I. Blue File PERMIT NO
2 Gold City . A1_ ~ 9~
3 Yellow Applicant Ut7J
ZONING (office use)
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(Phone)
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(City) (Zip Code)
ct< d-- /l( '>)') ~-~f71 C
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(Phone)
(Phone)
DATE
Type of Fixture
Rough-ins
Water Heater
v 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 $
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.5"D
.50
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Paid / / ..---
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Date L2 II
7- 7-0d).
Rec~~il S-
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