HomeMy WebLinkAboutPlg Permit 05-0140
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
Z. 23 ()~
I. Blue File I PERMIT NO I
2. Gold City . 0 s: 0/ 4-0
3. Yellow Applicant
(Please type or print and siltll at bottom)
ADDRESS ZONING (office use)
121?2!:- CJJ.r1i1LaL ~f -' 11::-! ,<; ~
LEGAL DESCRIPTION (office use only) ~
LOTILP BLOCK I ADDITION 1'J41U?llJ~ UY;6'k; j(.:r PID 'Z-\". !.,-Q1. OlfF.O
OWNER A A .' r I ( 1/\ It ii' Ii ~ I"II/'l'/\ ~ ,...
(Name) ~ n-f r / \_> tlf.,J.J./V cor ~
(Address) .~ / a..S (). b011')
CULLIGAN WATER CONDITIONING
6030 CULLIGAN WAY
MtNNETONKA. MN 55345
{Q~") Q~~-7~n.o
(Address) (City) (Zip Code)
(Contact Person) -.I\rp-"ti VLOv,. 11nJ an . () (Phone) fJl2;f ~ t{lff - 1 "h 7 0
.PPLlCANT SIGNATURE ~t~ 11J-~ aiL DATE? ... 4-- ~ fi
APPLICANT
(Name)
(Address)
Quantity
(Phone) tl 'O;r - ~;nf . 5hq ~
(Phone)
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)
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 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 $ ;fO/J ~
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ bCl . 1(10
$ .50
$ 4-0. 0 0
Building Official
Date
Paid 4e) ,UU
Date,,? 3 05
{..--.-z, ,
Receipt Naif/flit>
By jD1L-
This Application Becomes Your Building Permit When Approved
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
JhIo!>-
,; ,
S7J~- c;yjk~ / ~:tP
-i
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENT~: /
tJUa- -h/
SCHEDULED
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~LUMBING FINAL
o MECH FINAL
( \of~er
/
/l) /
( -/ 1'---
TIME
~/7'fJ
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE Rl
o FIREPLACE FINAL
o GASLlNE AIR TST
o
,
r'
KWORK SATISFACTORY, PROCEED
/ ~ CORRECT ACTION AND PROCEED
o CORRECT WO~K'i~L7~ RElNSPECTION BEFORE COVERING
Inspector: // M ' Owner/Contr:
V .
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
~ 1l.EQUlREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl