HomeMy WebLinkAboutPlg Permit 01-1169
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or print and sign at bottom)
ADDRESS
/0-/7 -0 I
I. Blue File
2. Gold City
J. Yellow Applicant
112~Y'
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APPLICANT -/G, /J /' /'1
(Name) ~-t...... <.( /,/?~../
(Address) /67 Y'd J2r~..~~; li::y-./{__
(~~ress )
(Contact Person) ~~, ~___ ~
APPLICANTSIGNA;URE .4d f-_~_-c
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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)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK ADDITION
(2U
OWNER
(Name)
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(Address)
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Quantity
PIDZI5' -37Z-00~-l)
(Phone)
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(Phone) C;~S 2 ' r~'\S "d?;o'
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(City) (Zip Code)
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(Phone) '-I" / Cf - ,;2 I '7 C
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DATE /~h :) /f/.:-'
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 $ f:::;fr - Building Permit # D I ,,{ I ~ i
PLUMBING PERMIT FEE $ 39. ~
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 4--0, c.XJ
(Office Use Only)
This ApPll#t:J:>fro~r Building Permit When Approved
YJY/ y [0 ~f1,o f
Building Official Date
Paid 4-0 A/V
Date I
I () - 17 '-0
:ceijt:
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
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/725'4 1)~J! ~,
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS: ~~e.r
DATE
TIME
/0 ~OQ
6 (-((& 1
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
/'
~RK SATISFACTORY, PROCEED
o CORREYfffiT I AND PROCEED
o CORRE W . ALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CALL~O FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!