HomeMy WebLinkAboutPlumbing Permit 04-0546
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please tvEe OT orint and siRn at bottom)
ADDRESS
l ~L ~~~Ii~", I PERMIT NO. () l/_ 5' 7r ~
~o& "7
806 a -;-- r:{VJ
I ZONING (office use) I
LEGAL DESCRIPTION (office use only) .--
LO~LOCK 3 ADDITION ~ 1~ lU Jiti!o flo.
,
PID.QS- J 3'?;2- OW-O
4/ (p-lb32.
. OWNE~ I \,> CI 1/
(Name) _ 'f) 'r t\. d ~ j ~ r- f) ~
(Address) 50 (p 7 ~o hcqt \ Y'.
~;;~~A;94 c.~ Y'<-~11'~c:l ,,\ b q (Phone) 1'~J-,'--I t, 9-4 D trh
(Address) ~~ 70 1) ~ I N ~ \,(J ro, \) L~K~v~/I, /'hN T;C)D'--J4-
(Address) (City) (Zip Code) !
(Contact Person) 10 h1 J.J d Lf..., (Phone) ~ I 2---;) 5' ( S ~ 7 tf
APPLICANT SIGNATURE ~ ~ DATE (,.,...-"7-0 (.{ !
(Phone)
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture
Bath Tub with or without shower
Dishwasher
I Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (1 or 2 compartment sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
I Stand Pipe (Washing Machine)
I Sewage Ejector
I Backtlow Assembly
I Backtlow Assembly Test
><.. I Lawn Sprinkler
- I 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 $
Building Penn it #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
~<:f. SO
_ .50
L-IO, ---
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
I Paid tf()--
I Datet.,___ 7~ l/
I
24 hour notice for an inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372.1714
Receipt No. 5~
L-/t..?' J
By
C
t:T
-....,
Date
o PLUMBING Rl 0 EXIGRADIFILLING
o MECH Rl 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
( .A 0 MEcH FINAL ~ 0
( /ld,uJ}? iliIYU/'r1.J!JJA---
j
CITY OF PRIOR LAKE
INSPECTION NOTICE
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30u7
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
)g:"FINAL
o SITE INSPECTION
COMMENTS:
,
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DATE TIME
SCHEDULED
c;{-JO -0</
B08~T 7Jt.<-.
CONTR.
PERMIT NO.
4---. 5 4-~
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~RKSATlSFAcTORY.PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WO":-~ALL FOR REINSPEcTION BEFORE COVERING
Inspector. vr:J--, OWner/Contr.
I I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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