HomeMy WebLinkAboutPlg Permit 02-0159
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
?,-/1-0Z-
1. Blue File
2. Gold City
3. Yellow Applicant
(Please type or print and sign at b_~~u_)
ADDRESS
/51. ZI.P fd~ waf// Ctrc/,e; Nt-
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
PIDU) -tJ 7/- (J()J-O
~~~R "-'Si!I!!<<J / LiLi van Ho-ut:en
152<6& Fti~water CircL6 Ale:
. ~.;~?ANT NOrlJlom f>wrnlJi?:/ (Phone) {{P/~)'6f)7-LfD??;
(Address) ;;tIOs flarttelli ./We, 57J mtJ/f> 55L1tff
(Address) (CitY)
(Contact Person) ~etf N fJYb ll5YV\-
APPLICANT SIGNATURE ~
(Phone)
{q?2)L/L!7- 'fdllc>
(Address)
(Zip Code)
(Phone) ( U I;') 8'~ 7--L/D>3
DATl!8/0;;-
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
I
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
~ 06 (:::J
Estimated Cost $ l" MJ, 1./ Building Permit # f) 2 -0/52/
PLUMBING PERMIT FEE $ ~. o.Q,.
STATE SURCHARGE $ . .50
TOTAL PERMIT FEE $ 'to OIl-
(Office Use Only)
This APP'l1~'Jf'::mes Your Building Permit When Approved
/!.JL!!r. Z, /Iq - 0 ?/
Building Official Date
Paid
4-0 .00
Date
Z~I f'd 1,-
Receipt N':4/Z3d-
BY~
24 bour notice for all inspections (952) 447-9850, fax (952) 447-4245
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CITY OF PRIOR LAKE
INSPECTION .NOTltE
""':
SCHEDULED
DATE TIME
2 ~...o -z.- 21 '?O
ADDRESS
15Zfj~ coGtbWrr/e;.,Je-
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o FOOTING
o FOUNDATION
o FRAMING (PJ
q INSULATION
t FINAL
'J SITE INSPECTIO
COMMENTS: ~ ~ \4t: \
II'
~_ ~Jl_ /
.,
f/
II
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o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
-e GAS LINE ~ TST :)
)t. I(tJ;- ?~
)( WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WOR~ FOR REINSPECTION BEFORE COVERING
Inspector: ' R I Owner/Contr:
~ALL 447-9850 FO;!THE NEXT INSPECTION 24 HOURS IN ADVANCE..
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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