HomeMy WebLinkAboutPlg Permit 01-0586
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3. Yellow Applicant
(Please type or print and sign at Lv.."~,)
ADDRESS
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CtG.. -; fA ~
osd. M-E.
LOr-3 BLOCK I
OWNER
(Name)
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(Address)
APPLICANT 11 /7{.
(Name) f:1s:..t.J't. Ji./..RI t./ I ..,4//;;n:;;
(Address) -.L'l.'7e>o {/:"7-E' fr
(Address)
(Contact Person) TD ./Y}
APPLICANT SIGNATURE (Jj11"Yr;
(Phone)
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(City)
(Phone)
DATE
PID;?~ . dS3 - Ct' a-l,~
(Phone)
t/'l7 - /7 ~c;-
tfr; q.-- '10 0 C
SS6tfC(
(Zip Code)
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APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity 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)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) 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 $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
,39 - 5iJ
.50
U IJ /----
,
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Paid /J __
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Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Rec~~f/5
BYSC
CITY OF PRIOR LAKE
INSPECTION '-OTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
DATE TIME
SCHEDULED
111-'] f)3
! ,~80
Vl/levw.tJu ~+~
CONTR.
PERMIT NO.
! - ,~Co
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:
G?
D. Y' ORK SATISFACTORY, PROCEED
V CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTlON B~EfOVERING
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Inspector: ~'\ ~ .; Owner/~ontr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl