HomeMy WebLinkAboutPlg Permit 01-0666
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CITY OF PRIOR LAKE PLUMBING PERL"VlIT
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An6.D0l.i1 ,.... (Yl.tV 55301-1
(City) (2i1 :Code)
(Phone) 'I \o~~<Jss-L\~~_
DATE 0~3-D\
(Ple~c: l.ype or ~rint and sij;\ll '-t bottom)
ADDRESS
)~9~ I _S(}.,J)lmrt C'YCLL
LE.GAL DESCRIPTION (office 1,l~e 0111y)
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OWNER -
(Name) "_ ShOvn\V'Qc.t ~i \C~_~_".n....__.____
(Address) \Y.~_._ ~n~~ C\vtlc _..J ~r\D( Lc0LL- _.__~
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APPLICA....-.JT --'\ \ 7\ '
(Name)___~_.....1?~_'::.y___ ~~
(Address)J~'-\\lf \--\CL\I~\-...J D\Ij~.
(Address)
(Contact Person) \e 8 ~\ciY\CU\
APPLICANT SIGNATU~U,.L _ L. ~
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"(ptone)
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APPLICANT PLEASE COMPLETE BELOW
Quantity
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I Paid tf 0 .LJ 0 i ReceiP~ ( g-~
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_,__..~,"'" _ L-:9 -(,.,-01 i By ttt,:
24 hour notice for all inspections (95Z) 447-9850. fax (952) 4-17-4245
I Quantity
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Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray 1'] or 2 compartment sink
I Shower Stall
: Sinks
IBar Sink -
__-~I~ter_~!osenfoiiet) ~______n.__.._
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FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39,.50 minimu~
Estimated Cost $
Building Permit #
PLlTMBfNG PERMIT FEE
S TATE SURCHARGE
TOT ..\L PERl\:IIT FE]t
$
$
'1:
(Officr. IJse On I;:)
I This Applicati~n-Becomes Your Building Per';;it When .~pproved--
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"-li:iidi~g Oftid,-I
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I Rough-ins
Water Heater
Water Softner I
Stand Pipe (Washing Mach Ile)
Sewage Ejector 1
I Backflow Assem-bly -.
I Backflow Assembly Test
I Lawn Spnnkler
1- Other
Type of Fixtu~!
Residential, New Onl: & Two-Family
Residential, Additions & Alterations
1$99.50
1$39.50
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.t3Q 5D
.50
ii/().no
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.. LAKE
IN NOTICE
DATE
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/q911-f:\ )~~ ~
TIME
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
.1- t;, c, ~
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI 0 EX/GRAD/FILLING
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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COMMENTS:
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4WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
WORK. CALL FOR REINSPECTION BEFORE COVERING
Owner/Contr:
129850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
"REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl