HomeMy WebLinkAboutPlg Permit 02-0694
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
g,-//- 01.-
I. Blue File PERMIT NO
2, Gold City eJl? -/./_ ~ ~-
3. Yellow Applicant (/" -V{g ~
(Please type or orint and si2D. at b" .."....)
ADDRESS
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ZONING (office use)
LEGAL DESCRil'uON (office use only)
LOT BLOCK
ADDITION
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(Address) 00150 UJ{X}'J loll ct< \)y .
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(Address) \lOlUQ J1r ~cl ct ~g ffith
(Address)
(Contact Person) Cl({}\ {1U
APPLICANT SIGNATURE ~U0tL
OWNER
(Name)
(Phone)Cf5/))\. 440- 1-2 I (l
(Phone) (f)0l ,-LfnG - PJ,lCj
I fLl<tvilLL ~5D11 L/
(City) (Zip Code)
(Phone)
Quantity
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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 REQUEST FOR INSPECTION
Water Closet (Toilet SENT TO CONTRACTOR. NO
RESPONSE - CLOSE FILE
DATE
h -/I-:At!) t1 ~
Type of Fixture
\
Rough- ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
Industrial, Commercial & Multi-family l'~ -r- ___ ~.~. _ ....n.JV IlIl11unum Kesldential, New One & Two-Family
J / /:) ~ Residential, Additions & Alterations
Estimated Cost $ / ~ 7 Building Permit # () z.. - 0 6" ~
,
PLUMBING PERMIT FEE $ :s 1. ~~
STATE SURCHARGE $ _ .50
TOTAL PERMIT FEE $ ~- rl./
$99. so
$39.S0
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building omclal
Date
Paid rv
~..
Dat~ -/1-1 'L-
Recei~Z-f (p V
By .~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245