HomeMy WebLinkAboutPlg Permit 02-0968
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3. Yellow Applicant
I PERMIT NOOd- jt&l
ZONIN~ce use)
R(
(Please type or print and sign at bottom)
ADDRESS
J .~-2 7' ~fEr<<IlS
.
fAft
; ,.
LEGAL DESCRIPTION (office use only)
LOi)..! BLOCK L/ADDITION
Il~CiCtl
.. {
f!Aw-r-
PID (:~- 3 810" ~ 17~ l)
OWNER
(Name)
(Phone)
(Address)
~~~;~~AN~t)onf 4- (J?ooflF j./A-r!3/L 7f{(Aft8,fo~ 7' 7- 31'11 -:2.j;2 /
(Address) 10"3:> b ~ 9'1 '^ A-I/? fJ !4/./(J/tJ#, ~3 71
(Address) (City) (Zip Code)
(Contact Person) rJ4-yf: ~ tJ() fZ6 (Phone) 7 b ] - :;2 "6 ~ 0 I '-I S
,APPLICANTSIGN~;URE _ft? 9c~ 0 DATE tZ'-7-0 '2.
'/ /'
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks REQUEST FOR INSPECTION
Bar Sink SENT TO CONTRACTOR. NO
. Water Closet (Toilet RESPONSE - CLOSE FILE
Quantity
Type of Fixture
:=J...
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
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 $
,50
L{/) i 00
,
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid J J 0 0
Vf() ,
Date g'1-0()-
Rec2!l~o7 / /
BY'Ot€-/
(J
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245