HomeMy WebLinkAboutPlumbing 03-0947
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT K, CALL FOR REINSPECTlON BEFORE COVERING
Inspector:
. Owner/Contr:
o FOR THE NEXT INSPECTION 24 HOURS IN ADVANCg,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
I/IlSNoTl
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
7. 19. 07
; ~~: ~:~ I PERMIT NO.O?-Oo.J -V
J. Yellow Applicant 7&f-' 1
~ase type or vrint and sign at bottom)
I ADDRESS
2g81 t:JOLJ cYJ r-
ZONING (office use)
~ 'L...-
LOT
LEGAL DESCRIPTION (office use only)
BLOCK
ADDITION
PID 7.-C;-)'8?~. o~2.. 0
C\/ ( fed :h-d
, . ./
L -z... f 00 D. V"I Q -tr-,,: I
(Address) [
'1'(YY\ ~c- (l
APPLICANT SIGNATURE ~~r~
OWNER
(Name)
(Address)
APPLICANT
(Namp\
(Address)
(Contact Person)
Quantity
(Phone)
.D i \AV1-11 : '" a
(Phonel q~ () q (, c; - (;000
Ld.~ u, 1((' -') s-044
(City) (Zip Code)
(Phone) _
I I
//;)(/0 "5
DATE
I
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture
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)
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backtlow Assembly
Backtlow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
lndustrial, 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 # ~J - d 94---;
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.::71. 50
.50
4(). (IV
(Office Use Only)
1 This Application Becomes Your Building Permit When Approved
Paid.. tV
4-() / l
D~ (Ya)
ReceiPtN)t ~O(" I
By d:-
O
Building Official
Date
24 hour notice for aU inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714