HomeMy WebLinkAboutPlg Permit 02-0628
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMI.'
1. Blue File I PERMIT NO ~ I
2. Gold City . /)7_ / -
3. Yellow Applicant (/;'\., <0
(Please type or print and si2D at bottom)
ADDRESS
~ \ 1-0 shtll\'I Covt tLt-
ZONING (office use)
RISD
LEGAL DESCRu:'uON (office use only) 4-
LOTa'-AOCK / ADDITION t2t~~ d . PIo;;JS-37t-()~,j
~~e~R ~ \ ~'! \~Q. n
(Address) 'SQ...W\....f
(Phone) Q50l - 44,0 -1403
~~;~~ANTI\_O-VQv\'s (Phone) lttd--&Q\ -6~O
(Address) Bo'l ll'd- G~ 653\1-
(Address) (City) (Zip Code)
(Contact Person) ~ (Phone) lol d~ 6"0' -6;).laO
APPLICANT SIGNATURE ~ '- - ~\ ~ATE elB%B
APPLICANT PLEAS~ c-bMPLETE 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)
Quantity
Type of Fixture
,
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE S\,;l:lEDULE
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 $
~q~/
.50
->Ir '-t n cg.,-
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 40,/
Date \5' 3)~
Recem /1 rr
By ,
r;v
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
DATE TIME
CITY OF PRIOR LAKE
INSPECTION -NS"nCE
ADDRESS
~ J"70
SCHEDULED (- 31 -C8
~<;Jlcdu ~jJf
CONTR.
OWNER
PHONE NO.
PERMIT NO.
!? ;; -t, p-~
COMMENTS:
o PLUMBING RI 0 EXIGRAD/FILLlNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 IGASLlNE AIR TST
cj MECH. FINAL 0
(J)/U.J/)1 \.--) ~
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
,
_ l c.V
II J It) ,/
L,./
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INS}lOTl