HomeMy WebLinkAboutPlg Permit 01-0303
CITY OF PRIOR LAKE
SEWER AND WATER PERMIT
(Please type or print and si~ at bottom)
ADDRESS
43/3 6~/N'fVOO1J Cte
LEGAL DESCRIPTION (office use only)
LOT )fBLOCK
Date Rec'd
4-- 1'2-0/
1. Green File I PERMIT NO
2. Yellow City .
3. Gold Applicant
ADDITION ~~/N'NOOP p~
.
t>tcA 11/
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APPLICANT PLEASE COMPLETE BELOW
OWNER
(Name)
(Address)
(Address)
APPLICANT
(Name)
O~/N ,pR...tJ
(Address)
(Address)
(Contact Person) 7]e/) y
APPLICANT SIGNATURE '--'~
P'
(Phone)
(City)
(Phone)
L-~J::,GVI ~
(City)
(Phone)
R../sn
PID Z5-an- O/fp- C)
(Zip Code)
(Zip Code)
DATE
tJI / r;)/tJ!
",
Size of water service inches.
Location of any couplings from structure feet.
Type of sewer pipe. D ABC D PVC D Cast Iron
Estimated length of sewer line feet.
Clean out (if required) located at feet from structure.
FEE SCHEDULE
Residential sewer and water line connection ~ Industrial, Com'l & Multi-family
Sewer connection only <:. $17.50 . )Water connection only
/'
1% of job cost with a $39.50 minimum
$17.50
Estimated Cost $
Building Permit #
SEWER AND WATER PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use 07 ~) . I
~hiS P <.at' Be~omes Your Building Permit When Approved
4-- ./L-,rJ ,
BUilding Official Date
$
$
$
/7.50
.50...
/PJ.O U
Paid J e~ (fV
Date A-'/V() I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
/
Receipt No. 3/j .3 rr
~
BY~
- /"
ADDRESS
1/3 !,~
DATE TIME
SCHEDULED Lf- I;; -0 I ~ ;cJV
Gra))U[Vood
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
PERMIT NO.
DI-0303
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING (Q' . 0 WATER HOOKUP
o INSULATION fi)ji SEWER HOOKUP
o FINAL lV [:] PLUMBING FINAL
o SITE INSPECTION . 0 MECH FINt:;
COMMENTS: 5~ ~
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~
~~ AVf- ~~"
d{- ~ I~ ~~
4 I ~ 0, 7 ot-- -fcJ p.P
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o ;"'RK SA T1"F"CtO~~::'::;;~'::;;;::;~
,)rl CORRECT ACTION JIlO PROCEED
o CORRECT WOR~ALL FOR REINSPECTION BEFORE COVERING
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.,
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYl
INSNOTI