HomeMy WebLinkAboutPlumbing Permit 03-1317
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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3_ Yellow Applicant
I PERMIT NOO3- /3/'11
(Please ~ or orint and sUm at bottom)
I ADDRESS 55;;1"1 ~UJ:oc.. -\- .
ZONING (office u"j
LEGAL DESCRIPTION (office use only) /J ~ .J ~ /I
LOi3BLOCK I ADDITION ~ R/l~J)~
~':e~R \J ~c. -\o~ ll(O---
~
APPLICANT f\.... .4 . _ I. ,,,...J_
(Name) "-'U'\.Y~ ~ 10. I
lDll\ ~e.D A\ ft S\.i )
(Addres~)
(Contact Person) DL\A...Vt.l 0
/' - 'PLICANT SIGNATURE ~~
PID~5~?5- m~-o
(Phone)
q6d-l\ 40 - 54~
. (Address)
(Phone)
In Id-8D 1- 6dl.o()
(Address)
(City)
(Zip Code)
to I d . 8D 1 - ,};:l(t(l
(Phone)
Quantity
~(" )~
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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
I Sinks
I Bar Sink
I Water Closet (Toilet)
DATE
Type of Fixture
t
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow 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
Estimated Cost $
III ()0..C2-
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
2>q.6D
.50
40,UL
~mce Use Only)
'his Application Becomes Your Building Permit When Approved
Building Official
Date
Paid i/O. -
Date r; -,;, 9 - 3
I Re~~ ~cJ
l<<fj
v
24 hour Dotice for all in., ..J._s (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
DATE
CITY OF PRIOR LAKE . /, L--
INSPECTION NOTICE SCHEDULED (/ b/~
ADDRESS S"S.-2 7 ~~ /01'...!e. el-
l/' CONTR.
TIllE
OWNER
PHONE NO.
PERMIT NO.
CJ3 - /3/7
[J FOOTING
o FOUNDATION
[J FRAMING
[J INSULATION
[J FINAL
[J SITE INSPECTION
[J PLUMBING RI
o MECH RI
[J WATER HOOKUP
o SEWER HOOKUP
.,P-PlUMBING FINAL
[J MECH FINAL
[J EXlGRADIFIWNG
o COMPLAINT
D FIREPLACE RI
D FIREPLACE FINAL
[J GASUNE AIR TST
[J
COMMalTSy /7/ /1 / /J
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~ij{ C-
~RK SATISFACTORY, PROCEED
[J CORRECT ACTION AND PROCEED
D CORRECT WO~~ypEINSPECTION BEFORE COVERING
Inspeelor: ~ k::::! Owner/Contr.
CALL "7-9850 FOR THE NEXT INSPECTION 2. HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY/
IJGNOTl