HomeMy WebLinkAboutPlg Permit 01-0495
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
5_2-+--0/
I. Blue File I PERMIT NO ~ I
2. Gold City . 1.( ~o
3. Yellow Applicant U
(Please type or print and sij!;ll at bottom)
ADDRESS
5C\~S
rhlA-Y k,Yt61l
'~yr,
ZONING (office use)
RUO
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION
PID Z5,,35O - (J 03 -- /
OWNER
(N ame)U I'? \f -' ~ () (Y)
(Address)~L.\1s5 o-'(}.:~I \L(\ ~ \ \ D..r,
r I
(Phone) Q>C; 2... - Y ~} - 4 () l.( ""1
APPLICANT
(Name) (~rl\rr4"'0 \'{\t:.~. y-
(Address) \lQ..-1-~O J::<fM~ \)Cl~
(Address)
(Contact Person) GtlVrkJY\ ffi(.,"\.( v
APPLICANT SIGNATURE J:1-"'l vl^
v--v--
(Phone)
~'{ ,.e v \ \\.f <; SOL{ y
(City) (Zip Code)
(Phone) CfS ~ - y ~ S ~ ~ 1 ~ u
51l--i/6 1
DATE
Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
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. 6l>
.50
~.OO
(Office Use 0 I~
Thi A tion Becomes Your Building Permit When Approved
/ b' *,p I
Date
Paid 4'0. 0 ()
. Date.s,U -0 I
Receipt No. 39(,.3.0
BF
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
INSPECTION NOTICE
.
SCHEDULED
ADDRESS .3 4 e s 13ttt.t k' ~ I ~
OWNER CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
..G\- ;a"'PLUMBING FINAL
o MECH FINAL
COMMENTS: ~felA <e/ rOl::::"
"
OA TE TIME
~-Ql.I-D:1 1/: SO
1-4q~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
/'
){'WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~.... ~~wner/contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl