HomeMy WebLinkAboutPlumbing Permit 04-0678
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
7. (;.01-
I. Blue File I PERMIT NO I
2 Gold Ci<y . tJ 1-, 0 " 71"
3. Yellow Applicant V
(Please'!vpe or print and siJm at bottom)
ADDRESS r:;. .-II _
1530"1
W(}O() .o{)VL 77U-.
ZONING (office use)
14
LEGAL DESCRIPTION (office use only)
LOT frBLOCK J ADDITION Vtl..ol.l,
PID -Z-r. 3 PI. 10 Z-_ ()
OWNER
(Name)
(Phone)
(Address)
(Address)
At'Lf(!d.,'f-f.7d V(vLvVt~'h3 (Phone) (J(9r;t.)t.;;;9- YtJtJo
2. "2. 7tJO ~ ;v'\(' 'P'r.<.. ( L..--a.I((( l< fie> '::;5-oC/9
(Address) (City) /'" (Zip Code)
(Contact Person) 10 ,,"" II 0 c '---- (Phone) tP f 2-) Z L; / - '39 '711
'PPLICANTSIGNATURE ~V~'-'l~ D~TE 7/v104
APPLItANT PLEASE COMPLETE BELOW
Type of Fixture Quautity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Slall
Sinks
Bar Sink
Water Closet (Toilet)
Quantity
Type of Fixture
APPLICANT
(Name)
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
Estimaled Cost $
ResidentiaL New One & Two-Family
Residential, Additions &. ~rations
Building Pennil # () f.. I (, '1 f'
$99.50
$39.50
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3".~
.50
4-rJ _ t:/ZJ
(Office Use Only)
J This Application Becomes Your Building Permil When Approved
Building Official
Date
'Paid At-.
'1V_"""
Dale 7,. fa. <> f-'
;PtN':J-7l- r?-
I
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
OA TE TIME
f?-;:;, 0 -() '-I
ADDRESS
153B4- /#OOD D.! 1t'..J::..
OWNER
CONTR.
PHONE NO.
PERMIT NO.
4-. h 7 r
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
iii' FINAL
Ib SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXlGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
L CU<.n1 S j).A.. vJd2Q..-<--
\ ,~ \f /
II \Y ( -
(j y\
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREC~WO , CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CALL 7-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
UUNOn
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