HomeMy WebLinkAboutPlg Permit 04-0070
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 01-05
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ADDRESS
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LEGAL DESCR!yuON (office use only)
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LOT BLOCK t ADDITION
OWNER
(Name)
(Address)
APPLICANT
(Name)
(Address)
(Contact Person)
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(Address)
APPLICANT SIGNATURE
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Quantity
APPLICANT PLEASE COMPLETE 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)
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IW Applicant L/'-f'" .. / t
ZONING (office use)
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(Phone)
(Phone)
(City)
(Zip Code)
(Phone)
DATE
Type of Fixture
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Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
I Lawn Sprinkler
I 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
(Office Use Only)
Estimated Cost $ ill ()-
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.1 This Application Becomes Your Building Permit When Approved
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.50
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. Paid (j~,__
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
Rece~~ g S' 5
By C
/
O~
Building Official
Date
DATE TIME
CITY OF PRIOR LAKE ~ftS-
INSPECTION NOTICE SCHEDULED
ADDRESS Jd)')t'Y.J ~~~~
OWNER CONTR.
PHONE NO. PERMIT NO. C/-7o
o FOOTING o PLUMBING RI o EXIGRADIFILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL o ~E AI~ TST
o SITE INSPECTION o MECH FINAL $- ~ '"~
COMMENTS:
. [)./
\ y~
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~RK SATISFACTORY, PROCEED
o CORRECT A D PROCEED
o CORRECT LL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
O~E NEXT INSPECTION 24 HOURS IN ADVANCE.
ENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
1NSN011