HomeMy WebLinkAboutPlg Permit 01-1046
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
t1,
1. Blue File I PERMIT N
2, Gold City
3. YeHow Applicant
(Please type or print and sign at bottom)
ADDRESS
~33
OrJ/C 5,
56
01
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2S -(Jft3 -fJ /5 -(J
OWNER
(Name)
(Phone)
(Address)
APPLICANT/? I I T I \) J '\ I '7S'z.'"-i i.o ~/ ~ ^-n .,.~
(Name) /T c.. c. r- e... Ci \, e. <:l \ : h'\. '::> I ~/ (P~one) ~ / L - 3 , ~ -to 5' \.L)
(Address) d 2 T-o 6 ~ I '" ,,-r- r 0.. 'J L ~ K ~ II , ) ) ~ '01 "f'"' 'S 5CJ '-I 'I
7. (Address) (City) (Zip Code)
(Contact Person) / 6 m _ J (phone) L, I 2- 3 ~ 5 (, r 03
APPLICANT SIGNATURE ~XI L)~ DATE ~ Z. l-tJ I
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)
Type of Fixture
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other~) ~
I-tOVJ(,' .
Estimated Cost $
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit # 0 I - I ()4-fo
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
39.50
. .50
4-0.00
(Office Use Only)
--
This APPlicattj n!~~ding Permit When Approved
BUildih~' Date
paid40.o0
~ate I
'2/ / () J
,
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Receipt ~<30.. /Jc-
'(7Jlovy
BIL-
.'-:'-
uF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
JklL~ U:
-. f
!JAIL.>c#, SJ, b,
SCHEDULED
~9S3
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
'% PLUMBING FINAL
o MECH FINAL
~
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
t!) I -/a'f'
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~,
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl