HomeMy WebLinkAboutPlg Permit 05-0416
CITY OF PRIOR LAKE PLUMBING PERMIT
~ l-\~
Date Rec'd
~ q. 05
I. Blue File
2. Gold City
3 Yellow Applicant
PERMIT NO. () 5. 04-/ ~ I
(Please type or print and si2Jl at bottom)
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ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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APPLICA~ ~. , ') \'"')\ h... ' (), c' 'I J 1/ Ci I.-Cj CJ 0-
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(Address) ;:}\\L\C1 -\-\ \y\"\j ~ZW \\v-L "J 4,~\)'\\lo (Y)t\.) (~t/'t
(Ad~s) (City) (Zip Code)
(Contact Pe~on) \Il (\t\ \\ ~ II ~ (Phone) 0f59 - 4&9 - (/11 q
APPLICANT SIGNATURE DATE
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 (J Y D
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Residential, New One & Two-Family
Residential, Additions & Alterations
B 'ld' P 't# Os. 04/~
U1 mg enm
39.56
~u50
$99.50
$39.50
Estimated Cost $
$
$
$
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 4--b, () 0
DateSII05
ReceiptNo'4Ql91
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
SCHEDULED
ADDRESS 2t:t ( g . .$"clocJ
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:
e
DATE TIME
Ir-:l..l/ar
s - '" / (...
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~GA~LIN~::'"
.A.-I-rl ,.
~YVORK~AT ACTORY,PROCEED
o CORREC AC nON NO PROCEED .
o CORR T yvrR. L FOR REINSPECTION BEFORE COVERING
Inspector: r ) Owner/Contr:
. / Y
CAW447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI