HomeMy WebLinkAboutPlg Permit 02-0972
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
303 '} il!u ~~A/ ();I- () . lU
1. Blue File
2 Gold City
3 Yellow Applicant
PERMIT NOO:2 - <97d-./
ZONING (office use)
P I 31)
LEGAL DESCRIPTION (office use only)
LOT I BLOCK I ADDITION ')) iJ1iIt./lj)l)t/ O~ f::.s-f cr l\Li.pm :J/i" 3-1/" ocR- ()
OWNER
(Name)
(Address)
Quantity
(0 (l /J ";
CL-rl'-c'k t-(1'tJ"-.us. (.'~J
3t)"37 U~ Jl--M'--- d (). w
(Phone) 9.s:A ..~;;Z~. ,- )llloS ~
(Phone)
7 ~- :.<. -
y?j"'--] 7 )0
APPLICANT _ "^-I ~7 /)/,-)
(Name) ~K.<~;V (.-( /U~_
_ ~L , . ()
(Address) /6 7 'Yv :r-r~ cd/( e./
(Address) /J
(Contact Pen<on) .~. c:;./ ~;r---;. 1'1
APPLICANT SIGNATURE ~.a- d' //LA-'J{
r I
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 ('()mn::trtm~nt <;:ink
Shower Stall
Sinks REQUEST FOR INSPECTION
Bar Sink SENT TO CONTRACTOR. NO
Water Closet (Toilet RESPONSE - CLOSE FILE
(City)
(Zip Code)
Y3('.--:5 7)0
(Phone)
9-..s- ;}..-
DATE
Type of Fixture
I
.
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
Estimated Cost $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit #
$3q~
$ .50
$ U()~
Paid l{ 0" -- ReceiPtll'~ ? I t:,
I Date ~ -R'----O 0-. By ~
U
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave" S.E., Prior Lake, MN 55372-1714