HomeMy WebLinkAboutPlumbing Permit 04-0677
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED 7 - 2 9'
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ADDRESS ;Z~ (!~ J
OWNER
CONTR.
PHONE NO.
PERMIT NO.
l! - &;rJ
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~. ASLINE AIR~!_ I t _. .
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COMMENTS:
/
/
~RK SATISFACTORY, PROCEED
o CORRECT ACTION PROCEED
o CORRECT WO REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CALL 447_~~.7' .. E NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUlREME ARE FOR YOUR PERSONAL HEALTH &I SAFETY!
/NSNOTl
Date Rec' d
CITY OF PRIOR LAKE PLUMBING PERMIT
-, (,.. 04-
I. Blue File
2. Gold City
3. Yellow Applicant
PERMIT NO. 0 tf. () (P"
(Please type or print and sign at bottom)
ADDRESS
284'Z, O~d~ 7YlA~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
,LOT0BLOCK / ADDITION Wd~ J.~
PID~ ? f'2. ~()l" 0
OWNER
(Name)
(Phone)
(Address)
A [C. (" <!d i tee! \> II.( 1M "=>,...... j
("2"l. 7 OD ~.'v\Q 1m 5-.
(Address)
(Con/act Person) . I DV'V\ tI DC l I \ . U.
. ''PPLICANTSIGNATURE ~~~ ~
I
(Address)
(Phone) fin)C{ (, 9 - it f)DD
L4 t(!v.~{(~ 5~ CJ9</
( City) ( Zip Code)
(Phone) (Sp/2) ~ l. i:; /q
DATE
- ,
APPLICANT
(N ame)
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
~ackflow Assembly
/" Backflow Assembly Test
" 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
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit # () if.. "I ~ 71
3f" 11>
.50
AD., cJV
$
$
$
Estimated Cost $
(Office Use Only)
Building Official
Date
Paid M'"'I
7V ~ v1.J
Date 7 L,
" (, . (J"r
Receipt No. A-7
() -r ~S7
Bil
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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