HomeMy WebLinkAboutPlg Permit 02-0747
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
,
I. Blue File
2. Gold City
3. Vellow Applicant
PERMIT NO. Qd_ 7!t'7
(Please type or print and sign at b~~~v.~)
ADDRESS
1<::]00 :Jel'H/:5
fJ/I-rh
(I,w,
ZONING (office use)
(<1_
LEGAL DESCRIPTION (office use only)
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LOT l.t/BLOCK 1./ ADDITION _.. ..
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OWNER
(Name) iN el/f Syv1V1v1 t1
OvA
PID~'" 3f' /, "0(;, h' ()
(Phone)
(Address)
APPLICANT
(Name) (}1 o ore ..J- /VI oore
(Address) / () S "7 b
(Contact Person)
;;L ~q t-0 rA w. 11.
(Address)
Ov1l~ Moore
Oa<-< //M t1'Jk
Wafer 1/etl(~'" +- (Phone)
{J 1'1 V'\ (' e f"r:) Y7
(City)
11111'
S--S-? 71
(Zip Code)
(Phone)
767l-;ZX6 -o/l../S'
6 -:1/-0<.
APPLICANT SIGNATURE
DATE
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
x
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 #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3 (} so
. 50
l'/()/ 00
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid , J' 0 CJ Receipt No. }
..,0. L/~'3~
Da~_a/-tJcr-BY~
(j
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 PlilOR LAKE
IN~p.fCTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDA nON
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
TI"
SCHEDUlED t,-.J. 'I-~ ff-
~'p
16" "3DO
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o W~ TER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
ft./J .A~r
DATE
~"'747
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GAS LINE AIR TST
o
A K SATISFACTORY, PROCEED
o RRECT ACTION AND PROCEED
o ORRECT WO~, CALL FOR REINSPECTION BEFORE COVERING
Inspector~ \,l)..l..u, Owner/Contr:
CALL 447-9850 FolTHE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IJ'/SNOTl
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