HomeMy WebLinkAboutPlumbing Permit 04-0970
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
,!Iease type or print and sign at bottom)
I ADDRESS
I? Is Lj II () r ,t c: CJ rt. -rr0-~ J
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 01-06
Q.J.;7, 0 4'
Blue File
Gold City
Yellow Applicant
I PERMIT NO.O~. OQ10 I
I
ZONING (office use)
R; 0 r ~o.A(t., 5..53 '7~
LEGAL DESCRIPTION (office use only)
LOT Z-BLOCK (p ADDITION d()O/CA,O~ eJ
OWNE~
~ame). ~
(Address) ? /S
2 t/.J1
PID zs". z9~. d~C ()
c8u~
APPLICANTWl./J ,11 , ~
~ame) ~ yJ...i{.&vJ
(Address) ~ 1 L. ? if) Q t.k\O 1), ~~.
(Address)
(Phone) 6~ I-,~ t::.5 -/(>3 '1ZJ
!=;~?1 Wi f1 -
(City
..5".5 / ct 3
(Zip Code)
APPLICANT SIGNATURE
~
(Phone) Sil m 'e....
DATE ?~q/LJ~
(Contact Person)
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher I Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 0 VEST FOR FINAL Sewage Ejector
Shower Stall REQ Backflow Assembly
Sinks INSPECTION SENT TO Backflow Assembly Test
Bar Sink HOMEOWNER 10-06 Lawn
Water Closet (Toil, jC>thei FILE CLOSED DlJ
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential.
Residential,
E
TO INACTIVITY
1/4/2008
Estimated Cost $ cO "Y9 ,. o-e.
Building PeIn3it # 0 tf--, () 970
lice Use Only)
rhis Application Becomes Your Building Permit When Approved
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
\.3Q..5 ()
.50
~o/ {j, t:JO
Building Official
Date
pai~. cH)
Date
9. z,7. 0
Receipt NO~1 830
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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