HomeMy WebLinkAboutPlumbing Permit 04-0084
.~.~
ell y OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
z,_lq.O~
I. Blue File PERMIT NO
2. Gold City .OA-, 00 4.A -
3. Yellow Applicant T o--r-
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
S08-C I=": ~A\'. Pc,/\4 ~, Se
LOT
LEGAL DESCRIPTION (office use only)
BLOCK
ADDITION
OWNER
(Name) <"Dr) (j G "Dr c:::t /1;5 ~th)..p , +
(Address)
APPLICANT
(N ame)
(Address)
S~ ~ ,q,\J(}.JC
CULLj-.jAN WATEA ,. .u..'.,..;i . .."'! '--., :., 'l\.f~
v ....." t. ., ..".....,
6030 CULLI12.AN W.D..Y ,
. (Mt_TONKA, MN 55345
(952) 933..7200
(Contact Person)
(OPLICANTSIGNATU~~
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 compa.lUlent sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
PIDZ,S". 4-01. Oz.+,O
(Phone)
(Phone)
(City)
(Zip Code)
(Phone)
DATE
~/'<..j C) L/
Type of Fixture
I
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
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 $ ~ Cia --
Building Permit # o~ ~()otJ4
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERl\t... FEE $
(Office Use Only)
0hiS Application Becomes Your Building Permit When Approved
Building Official
Date
37. sV
.50
L/O C' au
Paid ~. () 0
Da~ 1/ t1J~ 0'"
ReceiPt~, Z63
By if-
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE tillE
5.q {]G(
ADDRESS
~ ~ 0:11: ;?t
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
[] FINAL
D SITE INSPECTION
COMMENTS:
/~
/ /'
/ (
\
~
CONTR.
PERMIT NO.
D PLUMBING RI
[] MECH RI
[] WATER HOOKUP
[] SEWER HOOKUP
[] PLUMBING FINAL
[] MECH FINAL
!fJ- 0 S tJfT-
L{-~
[] EXlGRADIFILLlNG
D COMPLAINT
[] FIREPLACE RI
D FIREPLACE FINAL
[] GASLlNE AIR TST
D
---.
._~~
I by r;~ ')
, /
~
~
....~,,--
~WORK SATISFACTORY. PROCEED
[] CORRECT ACTION AND PROCEED
[] CORRECT A;'~OR REINSPECTION BEFORE COVERING
Inspector: , Y r Owner/Contr:
CALL 447-9850 FOR THE NEXT IN~PECTlON 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &; SAFETY/
IA... I~..j