HomeMy WebLinkAboutPlg Permit 05-0351
',I
J. iQF PRIOR LAKE PLUMBING PERl\'uJ.
" ", .
IS~7S '4~b ~//tt?Y."-} vfJE
APPLICANT ~ / L 0
'(Name)"\" ~Laf'es I~ .,p/~~1--7
(Address) I J L/ I" q ~ In r~11 Ai> c-.
" . I. . (~ss)
(contacl~~n) ~-( (2,.;. Ii- .s.> e.,I! r?) "
APPLICANT SIGNATU~~~~/'"")
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (l or 2 compartment sink
Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
i'.:
:. ~.
., . j'
:i'~EGA#J;~ESCRu- .uON (omce use only)
~~1:;.~,,'.'i'~ J;('}J,"~'i;~
LOT BLOCK ADDITION
OWNER y.: ;''''''/\ J j1
(Namej';::'\:IJ 111,1 nil LI ()r e.S
'(AAj2]~):.r;~:;';;' r+-,' ~ /Y""'l J J':
uu.I~'~'ir.?';-.'~V:;:' . ~ VI'" -' - '-w-"""
.;
Quantity
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office US,.,qnly)
l.TblSAPPUcation Becomes Your Building Permit Wben Approved
. BuUdlnl Official
Date
\
\.\
\
, \
\/
-.:--:;;:::::.:-:-:.7:".----- - -- - ,.- _.- .- .. ":":;:-.:::.:'. ::.:.: '..7::.:.:::.....: w,__ . . "0'. .... M.'" ~ ....."...... . .. . -- ,. . ..' .. -... . .
~: ~~ ~::y I PERMITNQ;':'i):(i~f~~":
3. Yellow Applicant :,.!",:r(~~,~:,~!KV,~:;~:~:i>:
PID zC, (jJ~.(l/O.O
(Phone) f '5.;2 tiLt 7 ~ ~71c;:: '
(Phone) f' 5:J - %7 L7 - 7 t1 q ( );.
Sl4vCLfe /YliV .!J1 ~7r
(City) . (Zip Code)
(Phone) 95,d. P9Y~ 700 (j
DATE - yi2t::7/ /Y,
Type of Fixture
1
.
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
I Backflow Assembly Test
I Lawn Sprinkler <u m71..j-. o,...q,.'" .'
I Other 'c.',) d' '.."".),." ':""V:',,, "
,.
, ',. .i, ";~i-
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Penn it # () (.; {):l q
3 7. 5'0
~a&J
.50
~~U/
Paid *'v(.A.J
Date
+, ~1/c's'
Receipt No. ;{fIr+"
BY~
/
'i '-,
24 bour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Ea&le Creek Ave., S.E., PrIor Lake, MN 55372-1714
. .
_.', "'-. --_. ~'._,,~-~,~_.~._,---
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
15;)" 7)
&cW~
...,
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
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
DATE TIME
t,/-zt~
)/_ r'
S- - 3s1
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
X L..~ ~~
~RK SATISFACTORY, PROCEED
o COR~E C N AND PROCEED
o COR C K, CALL FOR REINSPECTION BEFORE COVERING
Inspectc f: ') Owner/Contr:
CAU...44 _85~ THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IJ>ISNOTl