HomeMy WebLinkAboutPlg Permit 01-0990
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please tv1)e or Print and silD at boaom)
ADDRESS ZONING (office use)
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~.:': ~:~ I PERMIT NO'OI-OCJ901.
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LEGAL DESCRIPTION (olftce use only)
LOT
BLOCK
ADDITION
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I OWNER
(Name)
. (Phone)
(Address)
APPLICANT c: /"\ L ..... I,. 0 \ L . (') c:;, I II ~"-) I I 31 I
(Name) ...K.:...X'K.Xvr '\ UmDI(\j . (Phone) -, J~-""""'-1 /-\.0. ,
(Address) ~<:&OO \-id\\o.\\ CJrc.te CSz- ~\-\O\ lo..k 5S372-
(Address) (City) (Zip Code)
(Contact Person) 6e..\'~ scl~e.r- (Phone) c.o \ L. - It..! {- 3D83
APPLlCANTSIGNATU~Cf--'~ DATE Q\Q\o1
APPLICANT PLEASE COMPLETE BELOW
Quantity j Type of Fixture Quantity I 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)
I Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink I Lawn Sprinkler ]
Water Closet (Toilet) I Other U)ataK" me.;\Qr" '1.rvsta\\a.tlofll
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FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Residential, New One & Two-Family $99.50
Residential, Additions &,:'~I~t~f~:SO;~~
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Building Permit # . .-... ....~ .....
s 3Q, 50
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Estimated Cost $
(Office Use: Only)
This Application Becomes Your Building Permit When Approved
Buildl... OmciaJ
Date
paid$l/O~
Date q-/I-O{
Rec~~; ~ 7
By r;u
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
.JR LAKE
.uN NOTICE
ADDRESS
/~I / t,
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
J!. FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
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k.
A . -r:-
SCHEDULED
CONTR.
PERMIT NO.
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o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
pc PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
(Ifd~
-
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f
o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
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I
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,_
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTJ