HomeMy WebLinkAboutPlg Permit 01-01274
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or print and sign at bottom)
ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
OWNER
(Name) D t1 N J:? rP A C k &= I J
(Address)
APPLICANT
(Name)
D A ll3 ./ J::) L v 1}1 13 j AI ,.
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jj/,J1.. ifr\..$T 'iitTII &7.
(Address)
(Contact Person) Ct/....sJ. ~ J::.. 9 A L. l~t
APPLICANT SIGNATURE ~/~&~
(Address)
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)
I. Blue File
2. Gold City
3. Yellow Applicant
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PE~n c77jIli3~_
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PID
(Phone) q, f."" .1 :;JG . l) i.) ~
(Phone) I.'!);} - 8' t 1- 65(, (,
t1 LI1 0 rill N G""'o .v5f it (~s'"
(City) (Zip Code)
(Phone)
DATE /1- & -0'
Type of Fixture
I
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
Estimated Cost $ J 0 cJ
PLUMBING PERMIT FEE $
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This APr'epj~"d;ng Pi~~;~w:noAi"'oved
B'uilding Official Date
)
~
Date 11-1-{) (
By
---
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
DATE
CITY OF PRIOR LAKE J I J,.
INSPECTION NOTICE SCHEDULED If-9 ft I
ADDRESS 3/3Lf ~ ~ /1',
J
OWNER CONTR.
TIME
A..ti
PHONE NO.
PERMIT NO.
tJ/ - I,;J 71
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~ FINAL
o SITE INSPECTION
COMMENTS:~ ~
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
.
O~
r:~e ~, '€-
/
~RK SATISFACTORY, PROCEED
. 0 CORRECT ACTION AND PROCEED
o CORRE~~1' CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~Lu...tI Owner/Contr:
CALL 447-9850 FOR tHE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI