HomeMy WebLinkAboutPlg Permit 01-0584
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please tyoe or Drint and sign at bottom)
ADDRESS
2(( d I ct:f'AfJIA J/taJ
v
LEGAL DESCRIPTION (office use only)
LOT /3 BLOCK 4- ADDITION G/..-tlAlL'(//'ff'l::...~ S OU/lrl
OWNER , I _ _
(Name) tJ cf?/f,-tP'Ma1/\.. )-If?YI/l.t.::J
(Address)
APPLICANT~.. / f' /;; ~ "
(Name) ~Q..1I-1f ~Jtct,
(Address) c::;; y) oJ IA~, 40-11/<
(Address)
(Contact Person) gC/h,,-r ~
APPLICANT SIGNATURE i:rI'-t4~~z.._
'- Blue File
2. Gold City
3 . Yellow Applicant
(.-O~f4-
(Phone)
PID 2-S ... :~0 < - 0 2R-1.)
tHflfl-
~/)-,<19 /~/2
. (Phone) (P I J- S- .3 Y ~ S) /;"
HeaJ IHtu $1( ~-W~~
(Ci~) (Zip Code)
_ (Phone) (/ /1- s-:? cy t? SJ(/
DATE ~ ~/..?--rJ'/
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity I Type of Fixture
Bath Tub with or without shower I Rough-ins
I Dishwasher I Water Heater
I Floor Drain ( I Water Softner
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundry Tray (lor 2 compartment sink I Sewage Ejector
I Shower Stall I Backflow Assembly
I Sinks I Backflow Assembly Test
I Bar Sink I Lawn Sprinkler
I Water Closet (Toilet) I Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $
Ill-
II) av
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit #
~.57J
.. .50
4t:J .(nJ
Pai~ " ri.)
Date. J
b I I 3 .' tJ
Recei~ a q
By fl
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
~!/d-I
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
kD INSULATION
~INAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED ~-13??1 r::2/"dz;
,
q~~~
IJ CONTR.
PERMIT NO.
1- S-Ri
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR 1ST
o
mL) S~G::t~
u
(\
! 'f---
r rJ.f \.
\,.c., \\)-
\\ \)'-l "
'v . \\. ,
\il"
/"~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREC(JO~~, CALL FOR REINSPECTION BEFORE COVERING
Inspector: _."" U..'ll.,U.J Owner/Contr:
CALL 447-9850 FOR T --IE NEXT INSPECTION 24 HOURS IN ADVANCE._
~
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI