HomeMy WebLinkAboutPlumbing Permit #03-1518
~)
~,~J
~JVE5~
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
/2-.1-3.1)3
(Please type or Print and si~ at bottom)
ADDRESS
I eft qL( 11::> ~
REQUEST FOR INSPECTION
SENT TO HOMEOWNER.
FEB. 2004
I. Blue File PERMI NO
z. Gold City 1. 01 '? . /.' L J t'A
l. Yellow Applicant ~ .::;)1 U
ZONING (office use)
fdve- /Ve-
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
OWNER ~ ~ G \A. ,J,,~
(Name) 34-~ .~ ~~
(Address)
J:'lU zS. 2..0'5". O~. 0
(Phone)
APPLICANT
(Name)
(Address)
.. .. < : ! ('. A " (phone)
... -. \,. .. . rr.;;".: '"'/A.r;:::q f"{';.A t..,...
;'.i': . r,- . ' . ...., .--r'" d) H)....n '>f
vd,)V "''''!J t I I r'; ..~ f~ .''''' ..,.. f "
(Addr~~s)~'~"t. ~(}~~l'~;\. -'~"r'~ '~''''''';' (City)
~ ~ ' ..~.. ~. .. '\. t ~) ,. ~... r~..- \.
(Zip Code)
(Contact Person)
~. uPLICANT SIGNATURE
(Phone)
DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough- ins
Dishwasher Water Heater
Floor Drain I Water Softner
I Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compa.L.uent sink Sewage Ejector
Shower Stall Backflow Assembly
I Sinks Backflow Assembly Test
I Bar Sink Lawn Sprinkler
I Water Closet (Toilet) 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 $
t'J06 ~
Building Permit # 03_/~/'f;
?J 1 '- 5'0
.50
'-IDOl o Co.'
$
$
$
PLUMBING PERMIT FEE
STATE SURCHARGE
TOT AL PERMIT FEE
(Office Use Only)
Building Official
Date
Paid." O. (J7)
Date /2-. z,J. OJ
Receipt N04"~ 0 8?J
......
(1.
"-'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
DATE TIME
CITY OF PRIOR LAKE ~ :13-<:1f
INSPECTION NOTICE SCHEDULED
ADDRESS 1Y1,_'1L/ ~A- ~/
OWNER CONTR.
PHONE NO. PERMIT NO. J - L5J2
o FOOTING o PLUMBING RI o EXIGRADIFILLING
o FOUNDATION 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 o GASLlNE~T
o SITE INSPECTION o MECH FINAL .x. I. \os 'Ctll ,. }
COMMENTS:
'poRK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECt2t5_ 0 K CALL FOR.R.EINS..PECTION BEFORE COVERING
Inspector: \ -/ j Owner/Contr:
CALL -9 0 _ ~ Tt:it: Nf-.xT INSPECTION 24 HOURS IN ADVANCE.
......
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNOTl