HomeMy WebLinkAboutPlg Permit 01-0465
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and siWl at bottom)
ADDRESSj / 7 \ -, I
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I. Blue File I PERMIT NO.aV-A J II r-
2, Gold City (Ii'" l.9 ~
3, Yellow Applicant
ZONING (office use)
I< ISD
LEGAL DESCRIPTION (office use only)
LoB BLOCKcX ADDITION 1~{J()IJcb- ;VAJclPII8S/~=??-O/I-<?
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~~~;~~ANT Ac of'eel rfpd ~ I ilLMbt ~
(Address) 7- 2 / 00 ~;II\ e ~~ I
(Address)
(Contact Person) TotlV'l I/OL~
APPLICANT SIGNATURE ~~M
I
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity I
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 I Lawn Sprinkler
Water Closet (Toilet) Other
OWNER
(Name)
..."TO~~
1~'7 (2
(Address)
Quantity
(Phonb <1~?J '-It; 7 - or, ,s-
(Phone) (5"2) 4(,Q - 'loC)O
uk~u:lIe ~S-rL.t1
(City) (Zip Code)
(Phone) (a,{V s"1- r;, 5'03
DATE
Type of Fixture
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 $ J ~ O. 00
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
Building Permit #
:3 q/~O
.50
4 D ,O()
f
Paid Lit), 00
D5/;~/1J1
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Rec~t~~o I
By /} ",'
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This Application Becomes Your Building Permit When Approved
Building Official
Date
,..,
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
!?I(~
.
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
'\sf FINAL
1] SITE INSPECTION
COMMENTS: .J.1;.iJ
DATE TIME
SCHEDULED 7=L/-tJl A I
~d~~~
CONTR.
PERMIT NO.
/- U~~
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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~ORK SATISFACTORY, PROCEED
( DV CORRECT ACTION AND PROCEED
o CORRECT ~ ~ALL FOR REINSPECTION BEFORE COVERING
Inspector: L- ~ / Owner/Contr:
J
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI