HomeMy WebLinkAboutPlg Permit 05-0576
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
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.-
~: ~~ ~~~ PERMIT NO.O'C", 05-"7/-
), Yellow Applicant ....J l(p
(Please tYPe or print and sign at bottom)
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Address)
PGAJ.
~1d.
1
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(Phone) 9 S..J -dS'6 -13"'Q
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APPLICANT
(Name) ~~ Sl~'
(Address)
\ d~ to~
PlUM k'l
.z IM-.. ~J<"
(Address)
(Phone) ~~ tr1J/.1t.oo
Sa.~,
(City)
5S"3?tf
(Zip Code)
(Contact Person)
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APPLICANT SIGNATURE
~
~~
(Phone)
~",^L
DATE
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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
V" 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 Pennit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3~,SD
.50
'-II)
(Office Use Only)
Building Official
Paid ~-(). 00
Date Date&. 20 ;9S
24 hour notice for all inspections (952) 447-9850, fax (95f7-4245
~e~eipt N~Ja 7
BY./&L
This Application Becomes Your Building Permit When Approved
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DATE TIME
CITY OF PRIOR LAKE 1 bJacs-
INSPECTION NOTICE SCHEDULED
ADDRESS 30,;t . ~eo!
OWNER CONTR.
PHONE NO. PERMIT NO. O~-S J("
o FOOTING o PLUMBING RI o EXIGRAD/FILLlNG
o FOUNDA liON o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL o GASllNE AIR TST
o SITE INSPECTION o MECH FINAL X:rt,.~ U',,^-
COMMENTS:
~RK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORR7J!iRK' CAll FOR REINSPECTION BEFORE COVERING
Inspecto : Owner/Contr:
I"i'\LL 7.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH .I SAFETYI
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