HomeMy WebLinkAboutPlg Permit 05-0403.
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
)
5.6.05
I. Blue File I PERMIT NO
2. Gold City . 05. 04-03
3_ Yellow Applicant
(Please type or print and si~ at bottom)
ADDRESS ZONING (office use)
/L.j2'-/1 r~Je~td L~ 1\)~~.
~:~~NT~ Pl~ (Phone) ~~IZJ 127-'IMJ
(Address) 29()~ UJu-tJ-l-Jcl 1J.vt... 60. 140/6 $"S'I~P
(Address) (dity) (Zip Code)
(ContactPerson) ~ t?Y P--J (phone) -1"'zlilI::YfJJ1
APPLICANT SIGNATURE ~ DATE ~h,/~r
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
I Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
I Water Closet (Toilet)
LEGAL DESCR1.t'110N (office use only)
LOT J BLOCK 1/ ADDITION
JuftLCi
I)-I~ 4-.tJ--
OWNER -r1 .
(Name) I hllKf J I -u-r I
. (Address) I..!f.l!fJ ~k.w~lJd L.....L A).b.'
Quantity
PIDZS. 21S-: 05/.0
(Phone) {q~2. ~ "'10 - 3s8J
,
Type of Fixture
I
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
Estimated Cost $
Building Permit # OS. 0 4-03
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
:? q . t:>7J
.50
q b. 00
Paid
.f tJ. Cfl)
DateG. C~. 0 r
Receipt No. #/7 ;/
BY~
/
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 "
Sk~'
, L--
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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
~MBING FINAL
o MECH FINAL
TIME
os- - <;/d <
.... --
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
COMME~ps: -* {" / /" /
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~ORK SATISFAC~~~"
o CORRECT ACTION AND PROCEED
o CORRECT ~EINSPECTION BEFORE COVERING
Inspector: . ,)wner/Contr:
,,"'-; ./
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
/NSNOTl
CODE REQUIREMENTS A.RE FOR YOUR PERSONAL HEALTH cl SAFETY!