HomeMy WebLinkAboutPlg Permit 02-0376
Dat"
ell i OF PRIOR LAKE PLUMBING PERMII
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1. Blue File I PERMIT NO
2. Gold City . d Z. -03 7~ '\
3. YeUow Applicant
(Please type or nrint and sien at b~~w_)
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ZONING (ofliceuse)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2'r-.n1 -OZ-Q-{)
OWNER
(Name)
. (Phone)
(Address)
(Contact Person)
(phone) <))2 "It, 9 - q,oo
L~'v;llt 5s0'-1</
(City) (Zip Code)
(phone) (C-rz) 1(,:?-6-5'DJ
DATE I 1/ /,,,10 2-
~;;~~ANT R((J~d;ted ~ '\AII1~/j., J
2. 2 7 {)O ~ ~ A e tr4~ I
(Address)
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APPLICANT SIGNATURE ')~~
(Address)
Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity I Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SLItEDULE
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 $
Building Permit # a z. - ():rJ "
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
:J 1. ~1J
.50
4dlJ) 0
(Office Use Only)
This Applic~~~n ~Aomes Your Building Permit When Approved
K/~ . t?,n'1"1-- .
Building Official Date
pa:4-o . ({1)
Date
4- "/1 /() -z.-,
ReceiPt~o/7 0 f
By fO--
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
. LAKE
...l'II NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED /... ;3/-63
'\.71 Id-~ (\ )h~--~ PI-
~ U
CONTR.
PERMIT NO. /') - '3" ~
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
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o WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector? R Owner/Contr.
. '-'
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
I/VSliOTl