HomeMy WebLinkAboutPlumbing Permit #03-1131
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
/5/cf7 t/~//6~.f
I. Blue File PERMIT NO. t13 _/1',;:) }
2. Gold City J ,
), Yellow Applicant
ZONING (office use)
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LEGAL DESCRlPTION (office use only) I
LOT I BLOCKd- ADDITIO~~' (71~L
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APPLICANT
(Name) ~/-1-)::;.&rf/O,,(. /?6'.i t1 /I~
(Address) /~'/ 6 '? 2/,,(J,e/l/J A//"e
(Address)
C/p~L
APPLICANT SIGNATURE ~ /?:7~
OWNER
(Name)
(Address)
(Contact Person)
PID0f5- 395- 015-0
(Phone)
(Phone)
9SoJ - f-1Y-760Q
5S3?t:P
(Zip Code)
c5;41v/l6'L
(City)
(Phone)
DATE
~1/03
APPLICANT PLEASE COMPLETE BELOW
Quantity I Type of Fixture
I Bath Tub with or without shower
I Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall
, Sinks
I Bar Sink
, Water Closet (Toilet)
Quantity I Type of Fixture
I Rough-ins
I Water Heater
I Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
I Lawn Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum
Estimated Cost $
Residential, New One & Two-Family $99.59.
Residential, Additions & Alterations ~
Building Pennit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
.50
pai3 9~ 0-0
Dat() r [}-5 ~ 3
~e~~ipt NJ; 5 33 b
BY~
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This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections: (952) 447-9850, fax (952) 447-4245
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7-uJ)
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
lS-l8L
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATE,R HOOKUP
o SEWE:R HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
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DATE nME
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o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
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fi WORK SATISFACTORY. PROCEED
o CORREfJ11 T N AND PROCEED
o CORRE T K CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CAL~ t. ~o FOR THE NEXT tNSPECTION 24 HOURS IN ADVANCE.
INSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &; SAFETY!