HomeMy WebLinkAboutPlumbing Permit 04-0324
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
f. 2:1,()4-
.... ~....
L Blue File
2. Gold City
3. Yellow Applicant
I PERMIT NO. 0 "1- ,,()JzA- I
I ZONING (0__) I
(Please type or print and sign at bottom)
I ADDRESS
5920 ~/~~'-
~ oGfi T/7A.-
LEGAL DESCRIPTION (ollice use only)
LOT
BLOCK
ADDITION
PID zo
I OWNER
(Name)
(Address)
~
(phone)
~
APPLICANT
(Name)
(Contact Person)
PJergMaPL PI U,I'I".I~ '11-3
"'l-II g f AP..nyt AVPJ
(Address)
C/.-r:'
(Phone) <=t~7_ -1...f'JZ_-Q)C '>t.
.Jordq/\ 55 '3Sz..
(City) (Zip Code)
(phone) '1>zZoo - 3/39
(Address)
<\PPLICANT SIGNATURE
DATE
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks #- Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cnst with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ Building Penn it # tJJj ,OJ z.-,...
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
J"n
W.50
~,
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
paid~ If)
Da".. 2.3. 6+-
Receipt No~" '1 tl
By
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 TillE
~~-
a,~L/z./ ;l',:jye
CONTR.
Cft/- 2'.2tr
SCHEDULED
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ~~
OWNER
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH Rl
o WATER HOOKUP
o SEWER HOOKUP
~BING FINAL
o MECH FINAL
o EXIGRADlFILLlNG
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
gL~
#RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FO REINSPECTlON BEFORE COVERING
Inspector.
Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNf)n