HomeMy WebLinkAboutPlg Permit 01-0513
CITY 'OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
L/5?() S~~
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LEGAL DESCRIPTION (office use only)
LOT t BLOCK 3 ADDITION k'fiJ~ 6
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OWNER
(Name)
~
k'qtc:+;'IJ~
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(Address)
APPLICANT
(Name)
(Address)
(Address)
(Contact Person)
APPLICANT SIGNATURE
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I. Blue File
2. Gold City
3, Y cilow Applicant
d)Jd PID;JS-339'-(J/L-?f)
(Phone) ~-tb5" - bS Lis
(Phone)
(City)
(Zip Code)
(Phone)
-
DATE S- ;)f-D/
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity I Type of Fixture
Bath Tub with or without shower I Rough-ins
Dishwasher Water Heater
I Floor Drain Water Softner
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundry Tray (1 or 2 compartment sink I Sewage Ejector
I Shower Stall Y 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 Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
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
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.50
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Paid I..ftJ rO ()
Dats / ~C;-O I
Recei~lj to L/~
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ADDRESS
L/S?D
TIME
.j--30-aj /tT
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CONTR.
DATE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCH~OULED
OWNER
PHONE NO.
PERMIT NO.
/- 5L3
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
o FINAL 0 PLUMBING FINAL
o SITE INSPECTION 0 MECH FINAL
COMMENTS: / ..tlIJ/77 ~
I
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
~ORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK' CALL FOR REINSPECTION BEFORE COVERING
Inspector: h.... t J 6...JJ.u Owner/Contr:
CALL 447-9850 FOR ~E NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTI