HomeMy WebLinkAboutPlg Permit 01-0491
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CIT': OF"PRIOR LAKE PLUMBING PE~'[T ...:.ate R..'d
: ., MAY 2. 3 t.UUf
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(Phone) 9s? 4~ 9-4 ooe)
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(City) _ (Zip Code)
(Phone) (&,.2) ? ~"3 .- (Q 505'
5" -7.S-tJ1
I. Blue File
2. Gold City
J . Yellow Applicant
(Please type or print and sign at bottom)
ADDRES~O ,
J 1 '~est\{!
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LEGAL DESCRIPTION (office use only)
LOT t BLOCK "2- ADDITION r$T /..v(} \- vU~ ~e,)a..1
OWNER
(Name)
(Address)
00.0(' rrh9*"1Q>
3901 \(Q 5~ t st, S,l./-
(Phone)
APPLICANT f\ I<,..f... _I Of \^
(Name) HC(feC!( ,eG . \:' UM');", i
(Address) ~ (/\~ - ~..... ( 7760'
(Address) I
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APPLICANT SIGNATURE ~(~
(Contact Person)
DATE
,
I PERMIT NO. ",
{') \f4~
./
rG(O-"~)
PID Zs '30:5.. 005-0
L.j{f'7-72((
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity I 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 (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink t Lawn Sprinkler
. Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $ '55'0. 00
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit #
$
$
$
S4.<;0
.50
~.-
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use 9"Il~ I ,
Tb;, 4a:~~.. Your Building p.,;t~tlroved ::,:-rf?
BuildlRg <ffficial ~ate , C:;/~ lor
24 hour notice for all inspections (952) 447-9850, fax (J52) 44i4245
Receipt No.
-S '1~ "Z.--)"
By iJ ~
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULEQ
ADDRESS
'- ~9o/
OWNER
cONTR.
PHONE NO.
PERMIT NO.
1-L/Cl.I
,
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:(~ 0
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
0, "_..~;;,,;~,::
...' .......
,/,- 7
'-
...._~
Vo/ J
-_--/
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
B/
Inspector:
Owner/Contr:
....... I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOTI