HomeMy WebLinkAboutPlg Permit 05-0924
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
9. 21 OS-
I. Blue File PERMIT NO 0 A
2, Gold City '0 S. 07 Z,.
3 , Yellow Applicant
(Please type or print and siRll at bottom)
ADDRESS 0'
/30 S7)
t::67J-F / JJ 9 7?);J
ZONING (ofliceuse)
LEGAL DESCR1r uON (office use only)
LOT
BLOCK
ADDITION
PID 2-5: r15. 0 If-. 0
OWNER
(Name)
(Phone)
(Address)
APPLICANT A r J I \
(Name) J ('" (' {' t.. t~ ,,"-l ~
(Address) h Lf 55 - 1<:]0
(Address)
(J (~ ~~
S~v
(Phone)
~5 1- Vb ~- ()o T<.
(City)
(Zip Code)
JContact Person)
C l,.~J
I!/ .?/J{
(Phone)
)PLICANT SIGNATURE
DATE
q -"2/-0'5"
Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Type of Fixture
y!J
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
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 #
() ,r o<?z, t/-
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
31.51.>
.50
4tJ, 00
,10ffice Use Only)
his Application Becomes Your Building Permit When Approved
Building Official
Date
Paid fr;---
Dat~ Z/. OJ-
Receipt NO'<1-'1tJ~ (p
/I
By ~.
(J
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
ADDRESS
/ -?tYSGJ
DATE TIME
?P~J
; -
i:~rlJ ,h9 ~ ~~
V
PERMIT NO. ~- 9.2,~
SCHEDULED
CITY OF PRIOR LAKE
INSPECTION NOTICE
OWNER
CONTR.
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
~UMBING FINAL
'0 MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS: /
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( L-~je-./~/ ~ )
kORKSATISFACT~ -~
o CORRECT ACTION AND PROCEED
o CORREC~L FOR REI~SPECTION BEFORE COVERING
Inspector: Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
lNSNOTl