HomeMy WebLinkAboutPlg Permit 05-1223
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
L Blue File PERMIT NO
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(Please tvt>e or print and sian at bottom)
ADDRESS
I Y \ 'J,
JI~O~Y
Av-f-
f'lt..
ZONING (office use)
LEGAL DESCRL.t' lION (office use only)
LOT
BLOCK
ADDITION
PID
(Address)
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(Phone) (952-) 'f4'1.... 2o~-S
OWNER
(Name)
APPLICANT
(Name)
(Address)
NOfbl ~ PfuW\h/vtj
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(Address) -
(Phone)
(~(7.) e>C:?-40~~
(City)
(Zip Code)
Quantity
,F'){ (Phone)
'41 DATE J, - ~o-c3'
~LICANT 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
':ontact Person)
I APPLICANT SIGNATURE
I
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 I % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
~50
UV ~
ffice Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid fa I t/lJ
Date r
/"l, "t). t
Receipt No. 50833
By I'll
24 bour notice for all Inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
DATE TIME
SCHEDULED /~~~J -
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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
/c,//cl/
OWNER
CONTR.
PHONE NO.
PERMIT 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
,.a-POJMBING FINAL
o MECH FINAL
COMMENT~ " /'
/4Dk~d
/
S-/.??3
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOlK;, C~~REINSPECTION BEFORE COVERING
Inspector: ~ ~ Owner/Contr:
, r
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
INSNOTl