HomeMy WebLinkAboutPlumbing Permit 04-0475
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(g, /~. 04--
(Please!VPt!. or orint and sien at bottom)
ADDRESS
\. Blue File
2. Gold City
3, Yellow AppliclU'11
I PERMIT NO. 04-. 04--7 S I
\Ll3\ 4
~\lA-~'a~cl -woJ
I ZONING(office..e)
LEGAL DESCRIPTION (office use only)
LOT /3 BLOCK I ADDITION I0MJI! ~ ~
PID Z-l. 1<' '2-. Ill:!. 0
OWNER
(Name)
Quantity
~ Ll \O.>..j V\1
~
Dt\.\J/\/S G) rrl ev (Phone) ,(p I a - 80 I - Odlo()
l.' 4 2->rlJ) F\\ r{ ~ H~~ fD,?{'1{)
(Address) (City) (Zip Code)
Wtdq, (Phone) ~ I d - 'Rto6- Lj 460
-_ ( (J)_ DATE
APPLICANT PLEAkcOMPLETE BELOW
I Type of Fixture Quantity
I Bath Tub with or without shower
I Dishwasher
I Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (1 or 2 compartment sink
I Shower Stall
I Sinks
Bar Sink
I Water Closet (Toilet)
l\~\n\'\
(Phone)
It Id-/Pq0-&lllo~
(Address)
APPLICANT
(Name)
(Address)
(Contact Person) N lI<J( \
PPLICANT SIGNATURE ~
Type of Fixture
,
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
I Backflow Assembly
I Backflow Assembly Test
I 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 $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
OCt .2()
Llf1..d&
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
Building Official
Date
Date~ . 17. ott----
ReCei" liA
.'p-
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 0
INSPEcnON NOnCE SCHEDULED ('S - JO -0 (j
I
ADDRESS / +3/4- B t.. UG 8/1UJ 7Jt..-<...;
OWNER CONTR.
PHONE NO.
PERMIT NO.
+,+75
COMMENTS:
o PLUMBING RI 0 EXlGRADIFILUNG
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
{'Y,d-uJ71 ~iJA.V'rt-~
j
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~FINAL
o SITE INSPECTION
IJ
V
c.-L
u-'
/-l0
\r l
~ORK SAnSFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector. ~ Owner/Contr.
I I
CALL ~7-9B50 FOR THE NEXT INSPECnON 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
uaNOTI