Permits - Permit# 10-15-82 - 2418 Black Lake Road - 1/1/1982CITY OF SPRING PARK
P.O. Box 452
4349 Warren Avenue
Spring Park, MN 55384
APPLICATION FOR INSIDE PLUMBING PERMITS
OWNER
ADDRESS
PLUMBER
ADDRESS
LOCATION OF PROPOSED IMPROVEMENT
STREET ADDRESS G� -���� %' ex z24�
PLAT D 6 / PARCEL `/O o d
h
DATE
PHONE
?HONE
-/i -7 - ,;--3 -
Base- 1st 2nd Base-
__Jrent oo/r__. Floor TFixtur_a.a—_- ent
/ I_ Floor Drains _
sets —
l_
Tubs._ . - - -- -- - -- - —
ns
r
s
Tray 1
shwaskier
1st 2nd
Special 4lastes
Total .. ---� / ---- - -
'30,00
FEE //
SURCHARGE
TOTAL
RECEIPT NO.
The undersigned hereby represents upon all of the penalties of law•that
all statements made herein are true and that all work herein mentioned
will be done -in accordance with the Ordinances of the City of Spring Park
and We Statutes of the State of Minnesota.
At-611cant
Approved
Inspector