HomeMy WebLinkAboutPlumbing Permit 03-1431
.,
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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1. Blue File PERMI NO
2. Gold City 1 .al,? - 143/
3 . Yellow Applicant :.}
(Please type or orint and sign at bottom)
ADDRESS
/55+/ n/~6~v (!,lie- f6
ZONING (office use)
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LOT
LEGAL DESCRIPTION (office use only)
ADDITION
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OWNER
(Name)
(Address)
APPLICANT
(Name)
(Address)
BLOCK
C'
r IV z.s-: O:JO. 0 10. 0
(Phone)
(JB:llif{" tI&U.
I S-S-V ;#adJ &.
(Address)
5'. c__
(phone) q 5'') - 440 - 1;J1f t:,
t.'1rbtJ( 5-.\]72...-
(City) (Zip Code)
(Phone)
(Contact Person)
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I PPLICANT SIGNATURE
Quantity
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DATE
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compallment 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
, J' Backflow Assembly Test
r ~ 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
(Office Use Only)
Estimated Cost $
Building Permit # 03-11-'3 /
.3 r; 50
.50
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PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PEAAul FEE
$
$
$
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This Application Becomes Your Building Permit When Approved paid~, (j 0
Date /d. vi-. 0) By
Building Official Date , I ..
24 hour notice for all inspectio~2) 447-9~~(952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372.1714
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/.{"J'"41 rt1f~lvl( L,(C-
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 WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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COMMENTS:
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DATE nME
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o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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o ~ATISFACTORY. PROCEED
~CORRECT ACTION AND PROCEED
o CORRECT WORK, CAL REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE N~X.T INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &I SAFETY!
INSNOTl