HomeMy WebLinkAboutPlg Permit 04-0881
CITY OF PRIOR LAKE PLUMBING PERl\'tll
Ii
Date Rec'd
8.~1. 04-
~.:~ ~:~ PERMIT NO. ~.oafJl
3. Vellow Applicant l)"'r (,I
,Please type or print and sign atbottom)
ADDRESS
(o37c/ LPtl J ~\<) *rr4Ce-
;1/&
ZONING (office use)
Jf../ SD
LEGAL DESCRt!' llON (office use ollUY)
LOT J 0 BLOCK I ADDITIqN
W IL..[) () 1'1 K-S
PID z5: 3(,4,.-. t;, o. ~'
OWNER
(Name) t: AJ.. '-1ltz.o"
!~ , Lt.""
(Phone)
(Address)
APPLICANT
(Name)
(!,I/ ~I r;,~
(Phone)
(Address)
(Addres~
(City)
(Zip Code)
(Contact Person)
/) .
L/
(Phone)
APPLICANT SIGNATURE
~
DATE
Quantity
~PLICANT PLEASE COMPLETE BELOW
Typ~ of Fixture Quantity
Bath Tub with or irithout shower
Dishwasher
Floor Drain:
Lavatory (Bathrootn Sink)
Laundry Tray (I o~ 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toi~t)
Type of Fixture
I
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
i FEE S\..:n~DULE
Industrial, Commercial & Multi-family i~ % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
'i Residential, Additions & Alterations $39.50
Estimated tost $ '{k:/){ 00
"
I
Building Permit # O+-. () 981
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
31, ro
.50
40( C)d
(Office Use Only)
This Application Becomes Your Bllilding Permit When Approved
Paid
4-0.() 0
Receipt No. f 177?
By f{lJ6"
.'
r--
Building Official
Date
Date
9. J. o+-
24 bour 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
DATE nMe
?~h7
~.t ".y ~'/d 09~'S wr
SCHEDULED
ADDRE$S
OWNER
CONTR.
PHONEiNO.
PERMIT NO.
b/ - Rr/
lJ FOOTING
lJ FouliIIDA TION
lJ FRAMING
lJ INSULATION
lJ FINA~
lJ SITEIINSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~UMBING FINAL
o MECH FINAL
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
lJ FIREPLACE FINAL
o GASLINE AIR TST
o
COM"ENTS:
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f'j /C
'--"'" {
. %'.. WOIl...K SATISFACTORY, PROCEED
! d. CO~ECT ACTION AND PROCEE
o CO*ECT WORK, CALL FOR R SPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSltOTl