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HomeMy WebLinkAboutPlg Permit 01-0823 Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT 1. Blue File 2. Gold City J. Yellow Applicant ~~a;;:;s~ print an, SbO be) ~,\ ~ ~ LOT BLOCK LEGAL DESCRLt'nON (office use only) ADDITION ~~/ - , \:)ci:oro. PIT:J;)S---QO!- ()t '1-0 (Phone) qs-2&LJO-t,&-J3 ,-<;537 J. OWNE~ \ ' \ (Name) ~'r\ 'C"'\ f2 \C\ e.-r , (Address) CULLIGAN ~ATER "CONOlitONINQ (Phone) OU",U \,;ULLluAN WAY MINNETONKA, MN 55345 (Address) (952) 933-7200 (City) (Contact Person) ~o \l... ~ ""'~ Y\.f:!.. (Phone) APPLICANTSIGNA;;;RE~"1:-Wft'l ~ DATE 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 Bar Sink Water Closet (Toilet) APPLICANT (Name) (Address) Quantity (Zip Code) 7JqJC)/ Type of Fixture Rough-ins Water Heater Water Softner Stand Pipe (Washing Machine) Sewage Ejector Backflow Assembly Backflow Assembly Test Lawn Sprinkler Othp- ....... - - n' 11. II .A :'\\ I~NI'V\ Estimated Cost $~ REQUEST FOR INSPECTION Residenti~ SENT TO CONTRACTOR. NO Residentis RESPONSE - CLOSE FILE .r J!.J!; S"-.I1I!.DULE Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum 'Building Permit,# $ ~q sD2 --- . $ . .50 $ L.(f)~' fL~ING PERMIT FEE STArE SURCHARGE TOTAL kl!..aMlT l'.I!.J!; (Oftice u~ GIlly) This 'Application Becomes Y o.r Buildmg Permit WIleD Approved Date P~d I.({l-OO Date [[, d. -0' By;/ Receipt No. BuUdIDl OfDetal U bour notice for aU iDJ~ioDJ (952) 447-9854(flll (951) 447-4245