HomeMy WebLinkAboutPlg Permit 01-1239
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I -' - 0 \
(Please type or print and siWl at bottom)
ADDRESS
s4~t/ - f-DX ~ I r-c;.; I
~. ~~ ~!~ PERMIT NO. /')'_ ''''7 2 a
3. Yellow Applicant ~-L
I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
VUflA~MAf\J J
i
4 ~..!
(Phone)
(Address)
APPLICANT
(Name)
/Il 0 (l K.- - !J!11J ~
l/),4r
(Phone)
7101. --;J~ 6.- () IllS-
(Address)
Quantity
~ddress) I j} /I
) ) A-IJ~ /I r {lIt} rL
~ --::::>
~":~~".-... . DATE II~/-t) J
~~:-;~UMPLETEBELOW
Typeof Fixture Quantity
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 Backtlow Assembly
Sinks Backtlow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
(City)
(Zip Code)
7? S .- d 8'6 - (} I t..j ~-
(Contact Person)
(Phone)
APPLICANT SIGNATURE
Type of Fixture
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 $ f;()CJ/O
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.3 9 ,~--o
.50
~ . {jl/
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 41J , W
Date /I ___ J
lLJ ..- (j J
::cep 7 [/:
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDU~ED
ADDRESS
S~3'-1 ~
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~ FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS: ~ ~
I
DATE
TIME
~ (J'/;
T~ Trt-,
'1:30
tJl- /2J9
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
""
~ORK SATISFACTORY, PROCEED
o CORRECT ACTlotf AND PROCEED
\
o CORRE~RK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: . '1::> V 0M4 Owner/Contr:
CALL ~7-9850 FOR T~E NEXT INSPECTION 24 HOURS IN ADVANCE.
lNSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!