HomeMy WebLinkAboutPlg Permit 05-0860
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
C;,{p.o~
I. Blue File PERMIT NO
2. Gold City . . Os-. 0 B(p 0
3. Ye\low Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
L~ aa. \
:r~Dr"\
Pa,<-<;.
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PIDZS-. J7v. Ol,tl. 0
OWNER
(Name) f\..r...B.R'f SC~.t.+
(Phone) -3s J - i-./'1o- dlaf,;?
(Address) ,~ ,;:)...:;)~
:\~.. r-~ ~<n....
APPLICANT D
(Name) d& X.~
(Address)
1 J y ~q
?JI.",bJ....
" ?
Z:f\rc,-
(Address)
~~
tiuL-
(Phone) .,.~~- ~'I-,(.,ol'i
~.&~ -:{J"-3 Ii'
(City) '>I (Zip Code)
(Phone) CfiJ - <?"1'-1 w '1~
DATE q-J-or
(Contact Person)
\PPLICANT SIGNATURE
~_1_,
I Quantity
I
I
,-
I
I
I
I
I
i
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity ,
Bath Tub with or without shower
Dishwasher
I Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall '
I Sinks
I Bar Sink
I Water Closet (Toilet)
Type of Fixture
.
Rough-ins
Water Heater
I Water Softner
I Stand Pipe (Washing Machine)
I Sewage Ejector
I Backflow Assembly
lJ3ackflow Assembly Test
./ r Lawn Sprinkler
I 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 Penn it #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
:3 cr. \'""0
.50
(Office Use Only)
ThiS" Application Becomes Your Building Permit When Approved
qo
Building Omcial
Date
Paid "1tJ. VV
Date f 7. () f-
~e:~ipt No. #}7y
BY~_
I
! .
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED ~~
,~~~
ADDRESS ---15:J ~ ~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
s-~()
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
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~ GASLlNE AIR T~
Ii La.\o.Ju I rUe ,~
COMMENTS:
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o COR~E K, CALL FOR REINSPECTION BEFORE COVERING
Inspecto Owner/Contr:
C L 7-9850~ THE NEXT INSPECTION 24 HOURS IN ADVANCE.
~~ENTSARE FOR YOUR PERSONAL HEALTH" SAFETYI
INSNOTI