HomeMy WebLinkAboutPlumbing Permit 04-0937
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
9-/~.0 4-
I, Blue File I PERMIT NO I
2. Gold City '04-. 0937
3. Yellow Applicant ,
ZONING (office use)
ADDRESS ~
16lu d () r,'5V\. v+ RCClOl
LEGAL DESCRIPTION (office use only)
LOT 5" BLOCK I ADDITION
17f13 '7kaJJ
PID ZEi"" Zfo7. C05.
:Address)
fZoV\. A \1\ \
~
(Phone) q 5[9' ~41. '" 49
OWNER
(Name)
~~;~~T Dt.Y\N\~ (D:d
Add,e,,) ~ 3 f\\.rt~W
(Address)
~ lK-K l
.PPLICANT SIGNATURE "
=ontact Person)
(Phone) told -DO I . 5d&O
Hut(klM.~ 55366
(City) (Zip Code)
~ tJ - 8(0 8 -44~~
(Phone)
DATE
APPLICANT PLE
E COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink I Lav
Water Closet (Toilet) Otl1 FILE CLC)SED DIJE
FEE SCHEDULE
Idustrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Residenti
Residenti,
TO INACTIVITY
1/4/2008
afo937
3'lf5D
,50
'iO: aD
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$
$
$
ice Use Only)
Date
Pai~ ^
-rO . V 0
Dateq" /V ~ ~4-
Receipt NO'.t/--711Z-
By
his Application Becomes Your Building Permit When Approved
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714