HomeMy WebLinkAboutPlumbing Permit 03-0764
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
~~cP l
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED ~_~l~
r~ IkLl {lt1
CONTR.
PERMIT NO.
,'Z" 7~rj
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL "
o MECH FINAL fl,
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GWl/ST
.)Y-(~w4
---
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
v
CALL 447-9850 FO~ THf; Nf:~T IN~PE<<!TIQN 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
INSNOTl
I;
Date Rec'd
CITY OF PRIOR LAKE PLUMBINQ PERMIT
~ . r( 9J
I. Blue File PERMIT NO
2. Gold City '(J.' '? -07,-4-
3 Yellow Applicant ..j ~
(Please type or print and sign at bottom)
ADDRESS 53"'1 tII~rl/AGe #/LL RD /I/, E, ZONING (office use)
f'If.IO/l L/f~/ I11N S537~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDZS - t sq - tJ (>(p .. 0
OWNER
(Name)
t!ht-Lf/f/YJ .::T: Bt{/lK.J./A~ r
53/'{ t!.A-L/21/1-6fS II/J.L /Ca/flJ
/liE
I.
(Phone) tlS;).-'/'15 -7~t 2-
,?~ U1.d:-, MAl ss-~ 7"L
(Address)
APPLICANT
(Name) WILLIJ1tv/ .:r-, $L//t.k/f/J/lr (Phone) 9,S::L-44.$' - 7r R 2-
(Address) 53,,/ CJ1/lL/~,04- ~D /1/& I'~OC~. //IN !>-S~7~
,
(Address) (City) (Zip Code)
8/J,L.. B4~/41f1'l-r (Phone) 95"1.-:,,/0/,- ~"2-
~ ~ ~ )?JATE 6-jl-o:S
APPLICANT ~ASE COMPLETEt/~;LOW
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
Water Closet (Toilet)
(Contact Person)
. PPLICANT SIGNATURE
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
I
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit # 0.3 -() 7cP II-
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
31.50
.50
~o.oo
(Office Use Only)
_.-1.
Building Official
Date
pai~, crU
Da%. /1.oJ
Receipt~.? tI-
BYe!
This Application Becomes Your Building Permit When Approved
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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