HomeMy WebLinkAboutPlumbing 03-1282
DATE TillE
CITY OF PRIOR LAKE Cf::~.a; At
INSPECTION NonCE SCHEDULED
ADDRESS l'5?V-{ 1..1. \A.Jl DJL:.k..-
OWNER CONTR.
PHONE NO. PERMIT NO. ~-/~7.
o FOOTING o PLUMBING RI o EXlGRADIFILUNG
o FOUNDA liON o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL )? GASLlNE AIR TST
o SITE INSPECTION o MECH FINAL ~..\IA irrl'.6~
COMMENTS:
YWORK SATISFACTORY, PROCEED
!;;"ioRRECT ACTION AND PROCEED
o CORR2WORK' CALL FOR REINSPECTION BEFORE COVERING
Inspeete : Owner/Contr:
CA ~.1 J FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
lJ ) -
COD~REMENTS ARE FOR YOUR PERSONAL HEALTH .l SAFETY/
INSNOn
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
i ZSf)J
I. Blue File
2. Gold City
J. Yellow Applicant
I PERMIT NO. 03 -IZt"z+
(Please ~ or print and sign at bottom)
ADDRESS
/5U 1- WoOD DUtiL
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDZ5': 382-. a;/.()
OWNER
(Name)
(Phone)
(Address)
APPLICANT J r I 7'\. .......1) PIB6
(Name) /...-CON U0<LJn .
~ 0 9 - l-:r'tj. ftv-L .J (l.S.P/tC7'>-' \
. \ (Address) . (City)
fJl/-.fe ID JD.L) ;!r/ /J /! (Phone)
'PLICANTSIGNATURE f~W~ DATE
v .
. (Phone)
'73I F?:J t
n- 3 Cj"'(
(Zip Code)
WfJ).2. / lfrl((j
7/'5.7/;'(
(Address)
(Contact Person)
Quantity
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
Sinks
Bar Sink
Water Closet (Toilet)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
\ IlJackflow Assembly Test
II Lawn Sprinkler
, Other
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 #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
37. blJ
.50
4-O.tJ ()
..(Office Use Only)
"his Application Becomes Your Building Permit When Approved
Building Official
Date
I pai~. (/7)
I Da~ V.oJ
Receipt ~& z 1--
By ,j).
cr
24 hour notice for an inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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