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HomeMy WebLinkAboutPlg Permit 02-0308 Date Rec'd ell l' OF PRIOR LAKE PLUMBING PERl\'u I +-.3-tJ'L ~: ~~ ~:~ PERMIT NO.OZ-- OI~O(). 3. Yellow Applicant ..;J (.I (Please type or print and si2ll at bottom) ADDRESS \ c::::. ') ~,~?J LO I let \~lj Cd- ZONING (office use) ,Ie../ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID ZS - JfJZ,.../08 ' () GerrlJ (Address) \ ~ I.3VJ?5 ~;;~~ANT L1fJY7l8i1 rru/lW (Address) \UijLtO Hpda-tL (Address) (\ l l':'lOr( .~ ....I APPLICANT SIGNATURE OWNER (Name) "\1;(;ll i nccr CO llrt'T~U(lj Qt (Phone) ~~~L/YO-.(~ ()~;- Pcttn (Phone) Cl5(J)-ltglJ~ '0l,(J )1 (1 (() ~\ li1J58DLJL[ (City) (Zip Code) (Phone) ~ 77 91~ ~C1 Y-- !J&:01 0 Lf I?;/rn.- DATE (Contact Person) H10lLtHct _ ~ll J ,Yt( / \J 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 ') r.nmnl>rtn'u>nt ..;.,Ir Sewage Ejector Shower Stall Backflow Assembly Sinks REQUEST FOR INSPECTION Backflow Assembly Test Bar Sink SENT TO CONTRACTOR. NO Lawn Sprinkler , Water Closet (Toitel RESPONSE - CLOSE FILE Other ,(4J!,)!;S",DJ!,DULE Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50 Residential, Additions & Alterations $39.50 Estimated Cost $ Building Permit # _ (J Z ". 030 e> PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ 31, ~ 0 .50 AtJ,07) (Omce Use Only) This APP~~i1 ~~mes Your Building Permit When Approved U{l/:J 4-' 3 "'O'Z- Building Omcial Date Pai~ 0 'rO.O Dat;.,. 3 ~- - 02- Receipt Njl5S ~ By JJf<--- / 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245