HomeMy WebLinkAboutPlumbing Permit 04-0664
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
7. / -1-.04-
1_ Blue File I PERMIT NO ~
2 Gold Ch, '0 "'..0'-'.
3 Yellow Applicant If' " "
(Please ~ or erint and sim at bottom)
ADDRESS ZONING (office use)
;;)"10'1 r O'jdr P.....4\"
[e..J
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDZ&".404-.02-8.0
OWNER]
(Name) dp "1:,,,_ cY\,o'("r
(Address) 07)10<'1 I'.....'jl'.r
(Phone) 3S"d-a3J-c')/Q,,,
p,,-+\...
APPLICANT .
(Name) ~ o..~p ..;,,\,..
PIUN\h;~
(Phone) q;Sd-- f(q..j- 7l.oc.
(Address) l.~" to q Z:^ t""^ 0.,),,_
(Address)
(Contact Person) (h",
APPLICANT SIGNATURE ~
.C:;~,f'-
(City)
(Phone) q:>a-eqL}- 71:.00
DATE '1-13. c...J
."i."::l7 8
(Zip Code)
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 compartment 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
Backflow Assembly Test
Lawn Sprinkler
Other
v
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 $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3Q.:)o
.50
l%.ao
(Office Use Only)
This Application Becomes Y our Building Permit When Approved
Building Official
Date
I Paid
I Date
Receipt No.
By
24 hour notice Cor all inspections (952) 447-9850, Cax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
DATE TIME
CITY OF PRIOR LAKE rJ
INSPECTION NOTICE SCHEDULED >5 -,;/0 -0 (j
I
ADDRESS 2 7 0 9' ?O (/ GrrA:- P r:J7H
OWNER CONTR.
PHONE NO.
PERMIT NO.
<f-. (;, G, 4-
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)!fFINAL
o SITE INSPECTION
COMMENTS:
o PLUMBING RI 0 EXIGRADlFILUNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
(~;:;H:Z~~
j
1\ S L.-
Ii!. 0 \ ~
V ,,F l '-.../
rt
~ORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~~ALL FOR REINSPECTION BEFORE COYERING
Inspector. ~ Owner/Contr.
I I
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADYANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
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