HomeMy WebLinkAboutPlumbing Permit 04-0503
Date Ree'd
CITY OF PRIOR LAKE PLUMBING PERMIT
; ~~ ~:~ I PERMIT NO./)/ 1_ c-/'\~
3. Yellow Applicant (/ 7 v~
(Please.!'tPe or mint and sim at bottom)
ADDRESS
142>1<? Rob~ {<d.
. ZONING (office use)
LEGAL DESCRIPTION (office use only) J
LOT ( BLOCK~DDITION .f:J.Jt1 b M ,::;t AP--
~fd
~
D~ wedC}1
lP I;), d.~ A\..r{ ~
(Address)
(Contact Person) l'J \ K'J('J \..0 eAt) I
C~ -7f.
\PPLICANT SIGNATURE ~'--:::::-- _ l .A ~ DATE
~~LICANT PLEA~OMPLETE BELOW
Type of Fixture I Quautity
Bath Tub with or without shower Rough-ins
Dishwasher I Water Heater
I Floor Drain I Water Softner
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundry Tray (lor 2 compartment sink I Sewage Ejector
I Shower Stall I Backflow Assembly
I Sinks / Backflow Assembly Test
I Bar Sink v Lawn Sprinkler
Water Closet (Toilet) Other
OWNER
(Name)
(Address)
APPLICANT
(Name)
(Address)
Quantity
PID;)S- 331-0dr-O
(Phone) QOd'QQt:>-777J
(Phone) q ~,;. ~~ I ~ -?i2t5~\toD
HuJC.kJ _l1 \Y)'V\ 65?60
(City) (Zip Code)
lD Irl-g{p~ - 44 50
5 - J() -()l.f
(Phone)
Type of Fixture
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential. New One & Two-Family $99.50
Rcsidenlial. Addilions & Alleralions $39.50
(Office Use Only)
Estimated Cost $
Building Penn it #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
~q,5D
,50
4() ,(J)_
I
This Application Becomes Your Building Permit When Approved
Building Official
Date
I Paid Lf~ ,---
I Date~ f} 5~ 4
Recetjgor;- ::/'7
B~
(/
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
(,:(';)0-0(/
ADDRESS
/4-378 /C.(}/!IN /U:).
OWNER
CONTR.
PHONE NO.
PERMIT NO.
+.503
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~FINAL
o SITE INSPECTION
COMMENTS:
o PLUMBING RI 0 EXIGRADlFtLUNG
o MECH RI 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
( '5{/hLm ilifYU/'r!JU.J/t.-;
j
/1
v
c.G
0--
(ot ~
\r t
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR RElNSPECTION BEFORE COVERING
Inspedor. ~ Owner/Contr.
, I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
UUNOn