HomeMy WebLinkAboutPlg Permit 04-0759
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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
7. 1,1"p1-
REQUEST FOR FINAL
INSPECTION SENT TO
,Rlease type or print and si2ll at bv..v_) HO ME OWNER 01-05
, ADDRESS
$(P7 ~JJ/WL)~ JT.
ilue File PERMIT NO
~:~ ~~Iicant . O~~ () 19J
ZONING (office use)
LEGAL DESCRIPTIONdoflice use only) /..1. a " j I7n ~ ~ rJ<1
LOT &BLOCK \J.DDmON lVUA~ ~ '\ ur r>-
OWNER
(Name)
. (Address)
Quantity
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A~ fYlt, S 7'111/ k (Phone) t/.s"2.- ~z..c:; - ~YC C-
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(Phone)
1:!"?-. ~ ~ Sf" - 8"" l6 ?
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APPLICANT H ~
(Name) ~
r
(Address) /6' 7YeJ
. (Address) (City) (Zip Code)
(Contact Pawn) ~ ~A' (phone) 9f2.- trfV- f"J?7
APPLICANT SIGNATURE ~Ji/ d ' DATE ~-:;ZJ-I!1Y
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
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ Building Permit # 0 tf-., () '7
PLUMBING PERMIT FEE $ .3 't5V
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ ro. (/t)
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 4t:J,. (/[)
Date /I ~
-Z j.,~,() yo-
Receipt 4(>,~'1
By f&-
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
~P:~~
SS-67 ~Q~d:~
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
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
,8'""PLUMBING FINAL
o MECH FINAL
TIME
t:7</- 75;P
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
COMNJE~:, ~ / /'
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"ORK SATISFACTORY, PROCEED
/1 CORRECT ACTION AND PROCEED
o CORRECT W9~~~OR REINSPECTION BEFORE COVERING
Inspector: I'pt/" ~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl