HomeMy WebLinkAboutPlg Permit 02-0868
CITY OF PRIOR LAKE PLUMBING PEAAl1.'
, '
Date Rec'd
(Please type or print and siRn at l ~ ~:~~)
ADDRESS
I. Blue File
2, Gold City
3. Yellow Applicant
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PERMIT NOi1~~loy
\46lD3
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B lu-lbLV d \ vOJ..J.
ZONING (office use)
LEGAL DESCR.1l:'TlON (office use only)
LOT 1 BLOCK 5"ADDITION 1</1/t? h
(Phone) to \ d - ~O ( - 5;;) & D
c~Wmse..vt 65311-
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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)
OWNER
(Name)
~O-V\. MD~
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(Address)
APPLICANTaf-\ - 0' <:...
(Name) CLV V\.....J
\?vi. 11 ~
(Address)
(Contact Person) ~t.V\..Y\ \~
APPLICANT SIGNATURE ~
(Address)
Quantity
1J1' / I
PID:;5-_~/O' 0l.(1-0
(Phone)
9E>d-4l.f 6.3111
(City)
(Zip Code)
(Phone)
5:l..N-
DATE
{- /S" - D-"L
Type of Fixture
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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 $
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Building Permit #
"39 so/
.50
....lD~
Paid I..{ 0 (,,--
Date? -!6-a
Recei~~S~b
By
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDut.ED
l
ADDRESS j '1/)';;' 3
OWNER
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:
,
aY\
DATE
o EXIGRADIFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
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o ,mRK SATISFACTORY, PROCEED
aI' CORRECT ACTION AND PROCEED
o CORRECT W~lCALL FOR RElNSPECTION BEFORE COVERING
Inspector: ~ Owner/Contr:
I
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl