HomeMy WebLinkAboutPlg Permit 01-1109
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sil!;ll at bottom)
ADDRESS
34-6 () eI21j.s"77r'--' U tetUA5
I. Blue File
2. Gold City
3. Yellow Applicant
LEGAL DESCRIPTION (office use only)
LOT 7 BLOCK -5 ADDITION /JL-. (/1 eJA! 57:11
OWNER
(Name)
(Address)
APPLICANT () ( . -L1
(Name) f\v' l ) (12. . h I. f I
(Address) '~Y,<;O Cyy.s4::) e,K, /V W
(Address)
(Phone)
/0-5-01 .
i' \-~
I PERMIT N~Jj/_11 01
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PID 2.s-04 25Z-02.9-()
(Phone) c,S..). - 4 L) ,-G l....J J g
{1'IOV L~ k€ srs ~ J d-
(City) (Zip Code)
(Contact Person) /) _" (Phone)
APPUCANTSIGNATURE ~ .(~j DATE
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
/0/</0 i
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
-
'P
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 # () / - / / ~ 9
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
J6"'!""~()1
. Date
$ --39. S7J
$ .50
$ A-f) . (JD
pai4-C , crV
Date
t 0 -~ -c)\
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Receir NO#~{, '---
By j/)(jl
/' -
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
C'--t-1I ,,~~
r -
CONTR.
() .;\
OWNER
PHONE NO.
PERMIT NO.
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:
(
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L)\
1
DATE TIME
1-2-Z. O~
r-
/ : c.(~
:~Y'~O
Dl_ II DG-f
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE ~IR TST (_.
~ L..\WIA I tt,., c...A.. ~
.",
)iwORK SATISFACTORY, PROCEED
o CORRETIf;CT N AND PROCEED
o CORRE _ R, CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
'/
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
JNSNOTJ
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!