HomeMy WebLinkAboutPlg Permit 02-0766
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File
2 Gold City
3, Yellow Applicant
PERMIT NO.O Z"O.7~~
(Please type or print and sign at bottom)
ADDRESS
5945
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ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
(Phone)
(Address)
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(Address)
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APPLICANT SIGNATURE 7~A/,---
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/(VL
(Phone) fJ"o<. ~S:S~J~"J b
1I[)~k.}.J ~ JrJ '(7
(City) (Zip Code)
(Phone) /;t.2 >>1 'tr't't(
D:TE ~/do'V
(Address)
(Contact Person)
Quantity
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)
Type of Fixture
y
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
Estimated Cost $
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit # ~ {)z.... ~ 16 ~
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
Jtf,5l;
.50
4--tJ. 1(/
(Office Use Only)
Date
pai~. en.;;
Oat. U -() '-'-"'
Receipt No. _
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By fA
our Building Permit When Approved
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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CITY OF PRIOR LAKE
INSPE~TION NOTICE
SCHEDULED
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING 0 PLUMBING RI
o FOUNDATION 0 MECH RI
o FRAMING @ 0 WATER HOOKUP
o INSULATION 0 SEYVER HOOKUP
~ FI~AL 0 PL\JMBING FINAL
rd" sl'n: INSPECTION J. 0 MECH FINAL
COMMENTS: ~
I
(i~~
A ("
0h.
DATE TIME
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o EXIGRADfFlLLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~(lWORK SATISFACTORY, PROCEED
J CORRECT ACTION AND PROCEED
o CORRECT WOR~L FOR REINSPECTION BEFORE COVERING
Inspector: ~ /' OwnerfContr:
CALL 447-9850 ~J.HE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!