HomeMy WebLinkAboutPlg Permit 05-1246
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Contact Person) ~
A.PPLICANTSIGNATURE d ~('\l~!' ~F~
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APPLICANT PLEASE COMPLETE BELOW
Type of Fixture I Quantity
Bath Tub with or without shower I
I Dishwasher I
I Floor Drain I
I Lavatory (Bathroom Sink) I
I Laundry Tray (lor 2 compartment sink I
I Shower Stall I
I Sinks I
I Bar Sink I
I Water Closet (Toilet) I
(Please type or print and si~ at bottom)
ADDRESS
<{)<6S fnkxo..c.\ -r~ ~~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
Q~ Scl\A\~(
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~~
(Address)
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APPLICANT
(Name)
CULLIGAN WATER CONDITiONiNG
6030 CULLIGAN WAY
MINNETONKA, MN 55345
~962) 93~_7?nl'.'
(Address)
(Address)
Quantity
I. Blue File I PERMIT NO J
2, Gold City . OS.!?.A /_
3 Yellow Applicant C. 'f"(P
. ZONING (office use)
c;s~ 7A-.
PIDc25". 3 ez . ()s1. 0
(Phone) <1 S ~ -L{D - );21]- I
(Phone)
(City)
(Zip Code)
(Phone)
DATE
S/(1~o5
Type of Fixture
J
Rough-ins
I Water Heater
I Water Softner
I Stand Pipe (Washing Machine)
I Sewage Ejector
I Backflow Assembly
I Backflow Assembly Test
I Lawn Sprinkler
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 $
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Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
$ ~ 9 ' ~()
$ .50
$ ~() - 00
Paid A:- ~
7" (J-
Date _
/7. "Z-#. PJ
Receipt No. L"7j L
() ~ {,'IO'~ I
BY-1.
C7
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
TIME
CITY OF PRIOR LAKE Q ':1 ~ .
INSPECTION NOTICE SCHEDULED ~
ADDRESS ?OB~ &b_~
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
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
- .-
\{ I (I (
L~ uK-- +-I~ ')
5" - 124tJJ
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS~ AIR TSTp,(
)(. \JO _~
7
l
) I
I /1
~
I
~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRE~. CALL FOR REINSPECTION BEFORE COVERING
Inspecto/_ / / Owner/Contr:
CA _~'-9~R THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI