HomeMy WebLinkAboutPlg Permit 05-0661
Jr
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I./LOS-
(Please type or))rint and si2n atl. .,....)
ADDRESS
/ 74- 8 Z. ""Dc.-er.f; e. \ cl
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 01-06
. Blue File PERM..NO
Gold City IT. 05. 0 '-...//
, YeUow Applicant "'tP
ZONING (office use)
"Df\ S E
LEGAL DESCRu- lION (office use only)
LOT BLOCK
ADDITION
PID zs: 4-07. 0#1. 0
OWNER
(Name) -::ro~ c;e.ph
(Address) SO rn-e
~lORd,n
(phone) C\S2 '-\4 D "35DlQ
APPLICANT
(Name) ~ \'\'D~\NC)'C 'Yl S.
(Address)
~ b.,b \)ocl.d Rd
(Address)
(Phone)
tCLqCl.tl
(City)
bS \ '?J-bS \ ~4 0
5~ \ 'L.. '"S
(Zip Code)
(Contact Person)
r---
. ?PLICANT SIGNATURE
~y-\S
\~1I0~~
(Phone) ~me
DATE " \ to 1 D 5
..;
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity 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 Lawn Sprinkler
Water Closet (Toilet) 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 # 05. 0 ft, tP /
PLUMBING PERMIT FEE $ '3c\.C;b
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 40. 00
(Office Use Only)
Building Official
Date
paid+O.O 0
Date7.//.()O
Receipt No. ##-?,
If
BY~
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
40.CO \-\-D
ADDRESS
/71! 2
DATE
$~6
jJeel)~ij ,dy
TillE
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
OWNER
CONTR.
PHONE NO.
PERMIT NO.
c--b{,/
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o ~R HOOKUP
~LUMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS: ... /
~nr
/1/
c..\o r"j;Yt e V-
/
~h--
( /1 L-
~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORKJf~L~l~REINSPECTION BEFORE COVERING
Inspector: _/~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
IN$NOTl