HomeMy WebLinkAboutPlg Permit 02-0733
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please tvDe or orint and sil!J1 at bv."u~)
ADDRESS
fJ;P\fiO
~Ood We%- or,
LEGAL DESCRu- uON (office use only) _ ~
LOT (" BLOCK I ADDITION / / ) 1f!ct:; ~
v-
0JVwvVU0 W \ tc,on
'hflCJV UJOocl ~ 1IV.
~~;~~ANT (\Mlf?Y1 ~{Y
(Address) \ ~14D 1dJ..tlrL~ Vanv
e1~ ~
OWNER
(Name)
(Address)
(Contact Person)
APPLICANT SIGNATURE
l. Blue File I PERMIT NO ~
2, Gold City . A ":)- 7
], Yellow Applicant (./C7'
ZONING (ofticeuse)
PU[)
PID2~- 33 7-01 t,-()
(Phone) q69l...44()-1~ 10
(Phone) q0~-q?JG-51lD
ta~~ . rnN'B*J~
(City) (Zip 'code)
(Phone) qS"'~ - L{?)t:; ~011 n
~ -
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 Sprinkler
Water elas REQUEST FOR INSPECTION Other
SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
Industrial, Commercial & Mult
Estimated Cost $ ,/ {f 9' ~
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit #
3q SO
.50
(Office Use Only)
This Application Becomes Your Building r ...." .it When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
~tJ,- ,
Paid $ L{{)/:f)
Dat-tq_ ;)
Receipt lJ':;. 3/ ()
By (f6
V