HomeMy WebLinkAboutPlumbing Permit 04-0971
CITY OF PRIOR LAKE PLUMBING PERMIT
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 01-06
..~lease type or print and sign at bottom)
I ADDRESS ~
. /5 5.3~ ~ du-t. LjJ. tJ.
Date Rec'd
9. J.7. () 4-'
~ ~~~. ) PERMIT NO. 04- O~.-,/ I
low Applicant . ..."
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOTt. OBLOCK 1- ADDITION , S LA N 0 V I 6 ~ I Sf'"
PID . 14-3. 03 0
OWNERlnl . c.jJ~
(Name) .t..Ju.J J J
(Address)
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~;;~~ANW 'fJ cp~~
(Address) C"~ "In ~ <-R~.
(Address)
m 1f121/
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(Phone) J..S I-~k 5 - /3 tit)
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(Phone) b_J) I '-31o~ -/8 L/l)
.dL/t4--) DATE '1/; ~ /" V
(Contact Person)
APPLICANT SIGNATURE
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher J Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 ~-- '" -- --~....._+ ....:....1, Sewage Ejector
Shower Stall REQUEST FOR FINAL Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink INSPECTION SENT TO Law- C'__:_1.1__
Water Closet (Tc HOMEOWNER 10-06 Oth SED DtJE
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum
FILE CLO
TO INACTIVITY
Residentia 1/4/2008
Residentia
Estimated Cost $ ~ ..!!J.D-
Building Permit # tJ ~, 0 17 I
T1ce Use Only)
rhis Application Becomes Your Building Permit When Approved
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
....?9.sCJ
.50
~" , ~.
Building Official
Date
Paid #J. (/IJ
Date A ~
. Z 7. ~~
Receipt NO'~1'.30
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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