HomeMy WebLinkAboutPlg Permit 04-0374
Date Rec'd
~ . , ()r () f--
elf 'i OF PRIOR LAKE PLUMBING PERMu
,I
I
APPLICANT ,l L
(Name) I-rr,<",~ ~ Id~ ttJ/OIi
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J 2-1f" f -?II/' /1 r-e:t /J
~
JJktl R,(J...,55e-11 /? (phone)
. A~ DATE
. t- PPLICANT PLEA;E COMPLETE BELOW
Typ of Fixture Quantity Type of Fixture
Bath Tub with or ithout shower Rough-ins
Dishwasher Ii Water Heater
Floor Dtain f'l Water Softner
Lavatory (Bathro Sink) Stand Pipe (Washing Machine)
Laundry Tray (I 0 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks I, Backflow Assembly Test
Bar Sink , Lawn Sprinkler ~ _ ~ 100:-
Water Closet (TOitt) I Other 19
FEE SCHEDULE
Industrial, Commercial & Multi-family % of job cost with a $39.50 minimum Residential, New One & Two-F.~
I Residential, Additions & Alterate ~39.50 ~
Estimated ost $ Building Penn it #
(Please lYlle or print and siRltatb".,",.,) I
ADDRESS I
.tl.35'I S tone (' reo- 1 t H:... <<-
LEGAL DESCR1.t' uON (office use oty)
LOT4VBLOCK / ADDITIqN ~(Jt,t/'V'I'~
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Sa- L ,ib.l-o
S'ton~~m/ PtrOJ
OWNER L-
(Name) , .s. ~
(Address) ~3s4
(Address)
,I-J)~
(Contact Person)
...-L-
PPLICANT SIGNA TU
Quantity
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
,,--
This Application Becomes Y our B~ilding Permit When Approved
'-----'
~/ Building Official
Date
I. Blue File I PERMIT NO I
2. Gold City . ~ 4-. 0374-
3. Yellow Applicant
ZONING (office use)
Ibt-
PID u-. ~f'I-. ot.f~ 0
(Phone) t:l5.:J- lJlJ _~ JLJ9/
(Phone) tf'S,2 -lffv-7~~O
.:;;: J'fz/~f~ ...:S'5~ ;7,r'
(City) (Zip Code)
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C;/9/ttJ.V
$ '3 ~ SO
$ .50
$ #) ()()
Paid A~
.. 6 ~(/1)
Date I
(J . ( CJ. 0 ~
n
Rece't7
By
,
24 "our notice for all inspections (952) 447-9850, fax (952) 447-4245
. 16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
CITY OF PRIOR LAKE
INSPECTION NOTICE
AopRESS 2~Lj
O~ER
P~bNE NO.
d
Ii
D IIFooTING
D FOUNDATION
D ,FRAMING
D INSULATION
o FINAL
D. SITE INSPECTION
CpMMENTS:
DATE TIME
SCHEDULED h - I !3
~ GTPJ
~
CONTR.
PERMIT NO.
<.{. ~ l)c/
,
o EXIGRADIFILLlNG
D COMPLAINT
D FIREPLACE RI
D FIREPLACEUINAL
D &:~~NE A TST
D.
o PLUMBING RI
D MECH RI
D WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
D MECH FINAL
7i,
~i
II.' WORK SATISFACTORY, PROCEED
CORRECT AC N AND PROCEED
b CORREC f .K, CALL FOR REINSPECTION BEFORE COVERING
,'nspector:
- 50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH cl SAFETY!
INSNOTl