HomeMy WebLinkAboutPlumbing Permit 03-1036
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
<r . L 0)
I. Blue File I PERMIT NO I
'Gold CI'y, 'o.';>_h...2L
J. Yellow Applicant :...,) If..l-;IV
(Please !VD~ or nrint and sie;n at bottom)
ADDRESS
.sOl$' $/JIFF- H&/bfm
ZONING (office use)
/"
/ M-I L
LEGAL DESCRIPTION (office use only)
LOT / BLOCK 3 ADDITION --t:mBM- 6usr iJHZI<..
PIDzb 4<J Z-. tJfo]. ()
. OWNER
(Name)
(Address)
PI/J.-rfE Jlom &..:5
lflS' MJ2fJ.I WiSr .~lIIll:!t,.
(Phone) /P6/- ~SS>.5ZZ/()
/SiJlrL. /#/.'
E- Aolln, ~_
APPLICANT . /
(Name) v~uel f;~.J/nflVnL
(Address) ~6o (gv.A/J..;;;.o AvE. <fOIU?Av1. r1Il/\
(Address)
(Phone) ~Z -~.z - 3/Z.j
S53SZ.
(City) (Zip Code)
(Contact Person) CII/l/S ~~ . ,# (Phone)
/- 'PLICANTSIGNATURE 1(' /7d- ;;::; If~ DATE
I APPLICAN~ ~~E~OMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (1 or 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
~h/o3
, ,
Quantity
Type of Fixture
, "
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backtlow Assembly
Backtlow Assembly Test
Lawn Sprinkler
Other
y
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 $
.:3'1. SO
.50
40.00
ur Buildinf,Permit When Approved
Paid
tfh,-
Dat~'"1_a..3
Receipt No, ~ /
t./,-J d.-Ic.r
By ~~
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
J
DATE TIlle
CITY OF PRIOR LAKE r _ /..~ /
INSPECTION NOTICE SCHEDULED "W.A7h~
, II'
S(:)/S- .6';:'# Aft p/
ADDRESS
OWNER CONTR.
PHONE NO. PERMIT NO. ~ -1Qj'~
o FOOTING o PLUMBING RI o EXlGRADlFILLING
o FOUNDATION o MECH Rl o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE Rl
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL .oI!I'15[UMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS:
....;i" W ~ /J. ( /1....5
~j/;S
Il/~-c'fr::s ~ b'~ ,,/
/ ~d("" '/ /2 r' O(,6p,/e- A~bh',.J. /-
~~!'t/t/C' I~_ A~t:1 ./
I'
(()~
LWORK SATISFACTORY, PROCEED
f ;;-- CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR EINSPECTION BEFORE COVERING
~
Inspector:
Owner/Contr:
CALL 447-8850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH 4 SAFETY!
INSNOn