HomeMy WebLinkAboutPlg Permit 02-0728
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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1. Blue File PERMIT NO ~
2. Gold City . /'\..., _ -, . ~
3. Yellow Applicant (../~ ~ c
(Please type or Drint and siJn1 at b_-,__)
ADDRESS ..
15~()\ ~L~\ VOJJ..
PV\ov loJ<L
ZONING (office use)
LEGAL DESCRJ..t' lION (office use only)
LOT ~LOCK ~DDITION W~ d AJci
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OWNER
(Name)
(Address)
~~e \ \ ex \-oJ \<QSO'\
5Cu"'-l
PID(15- ~;+3-0d3-0
~a;>r 441 ~dl&
(Phone)
APPLICANT A- fl lA'oo.'^' ""
(Name) \AJV l, J. ' .-...J
~'l 1 \-;J.
(Address)
.
(Contact Person) ~
APPLICANT SIGNATURE~
Quantity
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l-J
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)
(Phone) (. 'd-- &0 \ - 6;;)1 ill
GWkY\.~&3lY\ ~3\r
(City) (Zip Code)
~
l,!S!Od
(Phone)
(Address)
---
DATE
Type of Fixture
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 $ I '-l D ~
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERNUT FEE $
3'\ s~
.50
'-l D OCi/
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
paid$ if 0 ,DC)
Date fo-/~,-;;..,
Rec1.lN"30~
BYaG
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
INSPEC"FftiN NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
..J:)<I:JNAL
o SITE INSPECTION
/
COMMENTS:
DATE
TIME
(-3/-63
J.?";;l.Oj (~d ,()L.u:'/(, Ty-..
SCHEDULED
CONTR.
PERMIT NO.
Od-7~
o PLUMBING RI 0 EXlGRADIFILLlNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
o MECH FINAL 0
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o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
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CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
Inspector:
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI