HomeMy WebLinkAboutPlg Permit 02-0499
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PE nUl
(Please type or orint and sign at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(Address)
APPLICANT
(Name)
(Address)
Quantity
Industrial, Commercial & Multi-family 1% of job cOSt Wlm.. "'-_h.
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I. Blue File PERMIT NO #11
2. Gold City . . 0 z, r()
3. YeUow Applicant
ZONING (office use)
PID
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(Phone) t1f1fJl-LflJ5 -- ~1 0
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(City)
DATE
(Zip Code)
611/ ()~
Type of Fixture
Rough-ims
Water H ~ater
Water Softner
Stand Pipe (Washing Machine)
Sewage fjector
Backf1o~ As~embly
Backflpt As~embly Test
Lawn ~Jtinkl~r
Other
\
Resi~...~~;.J, lie, lOne & Two-Family $99.50
Residential, A d~itions & Alterations $39.50
Building Permit # _IJ l.. ~o +11
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(A~dreSS)
(Contact PeISOn) ~19n1~ (Phnne)
APPLICANT SIGNATURE \ ~ fVJ.kJut
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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
Si~ks
Bar Sink REQUEST FOR INSPECTI
Water Close SENT TO CONTRACTOR ~N
RESPONSE - CLOSE FILE 0
Estimated Cost $
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application I;&ecomes Your Building Permit When Approved
Building Offitial
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447- &2 &5
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