HomeMy WebLinkAboutPlumbing Permit #03-0912
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2 Gold City
3 Yellow Applicant
. PERMIT NO. tJ3 -qlc?----
(Please type or print and sign at bottom)
ADDRESS
ZONING (office use)
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LEGAL ~,EJCRIPTION (office use only) " .
LOT /~LOCK IADDITION ~aclou;tJ~
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PIrQ5' - 3g L/---- ()
OWNER
(Name) IlL I I-/(J~H ICili
(Phone) QS2--233-gg5Z-
(Address)
APPLICANT
(N ame)
(Phone)
(Address)
(Address)
(City)
( Zip Code)
'PLICANT SIGNATURE
1 I)
At Ik~ ~
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compa.llllent sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
(Phone)
(Contact Person)
DATE
7 /1 (? / ~_1
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
y
, "
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 $
8q~ Q{)
.50
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. .....ll)ffice Use Only)
Building Official
Date
Paid 00 ~ -
Date 1-/0-- ~
ReLll/r~ 0
BY~
'his 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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DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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ADDRESS L t{ t{1,R; (' ~ft'1,.p,
OWNER CONTR.
PHONE NO.
PERMIT NO.
, -9 ('2--
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
o PLUMBING RI 0 EXIGRADlFllllNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLINE AIR TST
o MECH FINAL 0
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~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
4t-
Inspector:
Owner/Contr:
CAll 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNOTl