HomeMy WebLinkAboutPlg Permit 02-1075
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (l or 2 compartment sink
Shower Stal
Sinks REQUEST F
Bar Sink SENT TO C OR INSPECTION
Water Clos RESPONS ONTRACTOR. NO
E - CLOSE FILE
I Paid ifo. ----' ReC?~~:rOO
Orne B ~-
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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
(Please type or print and sign at bottom)
ADDRESS '\1 (l (hL-\ (}.,. '(1/
(j\ (/ , 1V0vL r Dcu z. \ClIU CD B
LEGAL DESCRIPTION (office use only)
OWNER
(Name)
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l1~~Y ~r( noJ( \OJ'LL 013
LOT~ BLOCK if ADDITION
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(Address)
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(Address) I (OlLfO .U ()rlrlft \)ctrn
(Address)
(Contact Person) G-xOkcl~
APPLICANT SIGNATURE ~~ t~~
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Quantity
Industrial, Commercial & Multi-family 1% of job cost with a $3'J.JU 1111"....___
Estimated Cost $
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
I. Blue File PERMIT NO --r
2. Gold City . 6 ") -- /0'7
3_ Yellow Applicant '"
ZONING (office use)
RI
PID;;15 - 1'70'- ()39-0
(Phone) q6'3lAY!-I~
(Phone) ot091- L{?J0~ -Oil 0
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(City) (Zip Code)
(Phone)
DATE
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Type of Fixture
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 #
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.50
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