HomeMy WebLinkAboutPlg Permit 01-1229
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS t.. "-
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LEGAL DESCRIPTION (office use only)
LOT ) BLOCK 3 ADDITION ~o-? W p ;>r ~
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OWNER ~ r
(Name) V I (.( '^ l\ G V'Ct. '" IoV""'\
(Address) l...! (f) D b ~~hrj ~IvJ ~; I
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(Address) '2.. 7... 7 Dr) P I ~ e jY'c< .\
(Address)
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(Contact Person) v V' .. \, tiC> C l,......
APPLICANT SIGNATURE ~/~
I
I. Blue File
2, Gold City
3 , Yellow Applicant
PIDd 5- 349 - O/6'-()
(Phone)
(Phone) (GS-2\ ~(. 9- t/ovu
(/J./ev,'lIr ~ry)(14
(City) (Zip Code)
(Phone) c;, t '"2.) ~ 4- f ~ C- ~CJ :3
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DATE
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 I Sewage Ejector
I Shower Stall I Backflow Assembly
I Sinks Backflow Assembly Test
I Bar Sink " Lawn Sprinkler
I Water Closet (Toilet) I 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 $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
39. ~()
.50
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Paid Ljo ,C)()
Dati 0," 30-0 I
Receij C/7'71
By ff0
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DATE TIME
CITY OF PRIOR LAKE /
INSPECTION NOTICE 'lCHEDULED q {'3 ~3
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ADDRESS t{IoOfo U,~kJvJ. Va:Q
OWNER CONTR.
PHONE NO.
PERMIT NO.
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o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
o PLUMBING RI 0 EXIGRADIFILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
o MECH FINAL 0
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~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: 4J.. Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANOE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFEty!
INSNOn