HomeMy WebLinkAboutPlg Permit 05-0353
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
1. -Z f (<5"'
~. ~~~ ~!~ I PERMIT NO. 05. 0353/
3. Yellow Applicant . .
ZONING (office use)
/ S 4--/ 5 CR~i/ 6- e::r.
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2-5. 4-'IZ. 0/3_0
I OWNER
(Name)
(Address)
(Phone)
APPLICANT,# ~ .d
(Name) .L:'kh",u . .L:J4.e6'E'/L
(Address) /5Y/5 C:e.4Q'<!, cVe.<:.r /J/PJ
(Address)
(Phone) y>5r.fl- f/Y?,-.sz;s:;z
(Con~act Person)
~~~~
(City) (Zip Code)
(Phone)
APPLICANT SIGNATURE
DATE
.y:~tl-C/~
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray {lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks ./J Backflow Assembly Test
Bar Sink r Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit #
os.o3S3
Estimated Cost $
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid , (j. {J ()
Date a
If. 'Z- 1. () s'
Receipt NO." 9 (r
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
CITY OF PRIOR LAKE
INSPECTION NOTICE .-/
/5"Lf/5 .
ADDRESS ~ C~
SCHEDULED
Qf
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
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
I I_oAr ..
I~
TIME
cs-- ~S-3
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o ~L1NE.t TST
o .JI1~'i,.."
e
~RK SATISFACTORY, PROCEED
o CORRE CTlON AND PROCEED
o COR C K, CALL FOR REINSPECTION BEFORE COVERING
Owner/Contr.
LL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
lNSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!