HomeMy WebLinkAboutPlumbing Permit 03-1085
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
8. /(3. Q3
I. Blue File
2 Gold City
3 Yellow Applicant
I PERMIT NOo03-I08S!
ZONING (office use)
/ (P31/ DUi./UTJ-J /tt/6
K-z-
LOT
BLOCK
ADDITION
oY
PID 2S, 9oc-. osr~o
LEGAL DESCRIPTION (office use only)
OWNER
(Name)
(Phone)
(Address)
A.PPLICANT o:J
(Name) r)()~/\
-
Address)
{j; 7S?
/!-erYlfi-1. R,,r
w<=-bl I C/ S. f - S.J-
(Address)
(Phone)
~Y"J.d lt~'\.
(City)
(Ii 2-- ,)[Yr;( - (,/532
fi7D ,5:5352
(Zip Code)
'JPLICANT SIGNATURE
(Phone)
Contact Person)
DATE
~-/~,:)
APPLICANT PLEASE 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 )( Lawn
Water Closet (Toilet) I Other FILE CLOSED DlJ
FEE SCHEDULE
1dustrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential,
Residential, .
E
rro INAC1]VITY
1/4/2008
Estimated Cost $
Buildingpermit# OJ-lOgs-
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
39. 50
.50
4--0.00
lice Use Only)
Building Official
Date
pai~O. 00
Dat~. J e.o
Receipt N+5 z31
By
'his Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714