HomeMy WebLinkAboutPlg Permit 05-0196
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~:~ PERMIT NO. I)~. ()jll/._I
Applicant L IlV
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ADDRESS
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ZONING (office
use) <...
LEGAL DESCRIPTION (office use only)
APPLlCANTSIGNATURE (.~!;;l,n !-/z) DATE 3/ go
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (1 or 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
LOT
OWNER
(Name)
(Address)
APPLICANT
(Name)
(Address)
:Contact Person)
Quantity
BLOCK
ADDITION
PID 2.5. 23Cl. 02-7 0
7)ruJ/a WYLc-f--f-
~ 'I 6 l C p do- v~ L()Ci~L?(
(Phone)
McOU~j'~ &. 30i-,5
605 - 12th Ave So.
(Adlrl~ins, MN 55343
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(Phone) C("5~ -- (/-3/ ,-(7 U 7 C(
(City)
(Zip Code)
Q
Ic~
(Phone)
Type of Fixture
l
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 # i- 5. () /9C
PLUMBING PERMIT FEE $ ~t..cy-:)
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ dO, OQ
(Office Use Only)
Buildinl! Official
Date
Paid 40 (i ()
I Date./") .-, / C'-
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Receipt N~.. 4-885 z....
By / II /'t,~;;,
V~
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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
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
6/81
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
1 INSULATION
FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS: Jl1/ /1{[;/i:.., rf"c:rr/E:JL
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012
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DATE TIME
4"Z. L't- z.; ('
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S .1'l(P
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
/
C/ /<-
~TISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~~ REINSPECTION BEFORE COVERING
Inspector: /" ~~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!