HomeMy WebLinkAboutPlg Permit 01-0172
CITY OF PRIOR LAKE PLUMBING PERMIT
Datt.
5-/5"-..
(Please tvDe or !Jrint and sign at bv~;"'..u)
ADDRESS
1. Blue File
2_ Gold City
3, Yellow Applicant
PERMIT NO. 0/ - 0/72-1
33t31 6t-VN'W,4-t'~ VP
ZONING (office use)
,€z.-s 0
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
PID 2,5. 3S'2.-0It-/J
c
I
OWNER
(Name)
(Address)
(Phone)
(APPLICANT
~"J.J.....:,...-.
(Address) QYJ- ~ I~ 1M II
(Address) I
/l _
A~Uh
,(Phone) ~ /;2.-.("..:!V ~.)J ~
fiw~ ~~
(City) /I (Zip Code)
(Phone)
(Contact Person)
APPLICANT SIGNATURE
DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
I Dishwasher I Water Heater
I Floor Drain / I Water Softner
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundry Tray (lor 2 compartment sink I Sewage Ejector
I Shower Stall 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 # t}~(J I? '2--
(Office Use Only)
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3-9. rv
.50
~d~ Q"(/
"
s our Building Permit When Approved
Date
Paid ~d. rv
Date3_/,S; 0/
ReceiP~ tJ 12-
IB~_ /
:3 _/$""' P /
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
A~LAKE
.uN NOTICE
DATE TIME
SCHEDULED
3-19-0/ /I:. uV
ADDRESS
33S7 6'-'1rV WA (b---e.- TK-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
C> 1-0/72-
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI 0 EX/GRAD/FILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP ~ FIREPLACE FINAL
o PLUMBING FINAL GASLlNE AIR TST
o MECH FINAL --f:h..L) <;: 0 t=-I
COMMENTS:
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"-- ~ . .'
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---:- /
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
'",pecto" ~ Owne,/Cont"
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INSNOTl