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HomeMy WebLinkAboutPlumbing Permit 04-0899 CITY OF PRIOR LAKE PLUMBING PERMIT Date Rec'd I. Blue File I PERMIT NO. CJLI" JXlfl 2, Gold City _ 3 Yellow Applicant ADDRESS .3 l; I ?- 'f3 OL"- ~ 11.~e4-> Bit,. Yl. uJ. ZONING (office use) /? d-~'f) fitJ,. U ~ ~ - ltVlf! ..5.5 /.1...3 LEW ~CRlP'70N (office use only) LOT BL~ / ADDITION u:e7;:u s...,- PI~ 5 -:35 (j-OO /-1 OWNER ~ (Name) ) 12 ~ji.~ (Address) ,-'3 $/'). (Phone) ?5d.. - d. ~~ .- t ~ 5 I '7. n. ~5'63"~ (Contact Person) APPLICANTLj / 11 . /) "'. 1 L (Name) 1:1 l, '-1'-' '^fU-w~rL.a.) (Address) ~'" I} 0 fJ~&, '-I!cA.. 7~4<-) 1 t)1h. (Address) h1 ~ ~.Ll I C APPLICANT SIGNATURE (Phone) to 5 I - ~~ ~ '5 -I 3 <I tJ 55j~3 (City) (Zip Code) (Phone) t.5/ -.3~5 -/.3 </0 DATE sY//3/tJ 1 Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher Water Heater Floor Drain 1 Water Softner Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) Laundry Tray (lor 2 compartment sink Sewage Ejector Shower C'L_II Backflow Assembly Sinks. REQUEST FOR FINAL Backflow Assembly Test Bar Sm Lawn Sprinkler Water ( INSPECTION SENT TO Other APPLICANT PLEASE COMPLETE BELOW HOMEOWNER 01-06 Estimated Cost $ ~~, ~ . Building Permit # _ FILE CLOSED DIJE TO INACTIVITY 1/4/2008 fLE Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residenti: Residentil ffice Use Only) PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ ..39.5tJ .50 ~~ , d-t!J. rhis Application Becomes Your Building Permit When Approved Building Official Date Paid c.; tJ" ----- Dat~ _ f?- Lj 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714 _>O_,.______~_..._._~_.__.""_...".~ ....""_'''._.~''_._~"~~'"'.._.,~+,_.._,,___..__..