HomeMy WebLinkAboutPlg Permit 05-0430
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO
2. Gold City . A L_ J..I 30
3_ Yellow Applicant { / ::J -
(Please type or print and sign at bottom)
ADDRESS
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ZONING (office use)
LEGAL DESCRlt'TlON (office use only)
LOT}Cf BLOCK I ADDITION tt?J~ /EI- m IlJIY{fk;
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PID 3f3"O/C{-O
OWNER
(Name)
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APPLICANTh) I
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(Phone) 6~, "-1(, () ~tTYz.,-
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(Phone) b 5""/- f(,o -?rI2.- a...
APPLICANT SIGNATURE _1 f. ~ DATE
V 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)
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
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 Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
3Cf - 6-0
.50
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(Office lJse Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid Uo _--
Dated_It - s-
Receirt~1 t/;;-
B~
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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 ~ ~ "... l~'~ t.w.~ II'
~
OWNER
DATE
I(W~
~!r
TIME
PHONE NO.
CONTR.
PERMIT NO. _~ - 6' lj ?c
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:
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
Ill~ GASLINE AIR TST
A I;.,)d 1,"'-1
c
~ORK SATISFACTORY. PROCEED
h ~ORRE A N AND PROCEED
o COR CT W . ALL FOR REINSPECTION BEFORE COVERING
Inspect )r: 1 Owner/Contr:
C~l7.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!