HomeMy WebLinkAboutPlg Permit 05-0050
Date Rec' d
CITY OF PRIOR LAKE PLUMBING PERMIT
I. /3. Os
I. Blue File PERMIT NO
2 Gold City .O~. 0 02'""7""'1
3 Yellow Applicant ::::> ......,
,Please type or print and si~ at bottom)
ADDRESS
5g 3 to 1 nch{~n Kf'dqt!/C/rc;lu 5 E-
ZONING (office use)
M...L-O
LEGAL DESCRIPTION (office use only)
LOT 9 BLOCK Z- ADDITION tJ 11k- ~~1 0 c-c (!..T. / g
PID -z.s CJ 83. 031-. ()
~~e~R lLury ~(U~jer (Phone) q~~-Lj4J-d-q~
(Address) ~\'nU }f\ 0 ( \fL~ I yY) \-.-\' S:; ~ Jd-
APPLICANT \ \ If) {) '\/ , ~ "1. I _c:....
(Name) r;Y '\""'\ ~/OO( l\... ~ (Phone) lp J) - 0\0 J'-l ~L\O
(Address) ~1 0 Dodd R d fMan fY) N. Cj51 ~ ~
~rr~7;)i €h (P:~~
)~ r)07=_
(Zip Code)
(Contact Person)
~
) -5- 0'S
APPLICANT SIGNATURE
DATE
Quantity
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
Induslrial, 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 $ J.() 0 ; U 0
Building Permit # OS: {J (/5{)
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
JQ.5o
, .50
i..fO r DO
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid~. (/D
Date /., I .f: 0 S-
Receipt No. ~8f,m
By .1Ji!tE--
/
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-fO.a)
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
S-eJ6
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENT~ /
jX/a ilr
SCHEDULED
l~/~
~--<:Ii Q'L
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
A!!f1'[UMBING FINAL
o MECH FINAL
/ ;-
It~q fer-
~ /' / 4
C6~"6u...r r/tJ~ 4r
/ . ~
t</ / //
/ ' T
/'
6l/C
DATE TIME
Prk~
~~e
11
oS-,Q05V
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
all
A'ORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR INSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETY!
INSltOTl