HomeMy WebLinkAboutPlg Permit 02-1272
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File PERMIT NO
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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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)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name)
(Address)
APPLICANT
(Name) ~e,,7Zo.~~ IklP!6~,~~-
(Address) ~ -7 ~ G~ ~ /") ./1
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(Contact Person) ~_~ ,.Jr::l>-'" .
APPLICANT SIGNATURE~-( ::;;~.6 ~
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Quantity
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum
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(Phone)
(Phone) //<:
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(City)
( Zip Code)
(Phone)
DATE
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Type of Fixture
I
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit # tJ 2 - { 2 7'2.__
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Use Only)
This Applicatio~ ~ecAmAs Your Building Permit When Approved
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BuildingOfficial Date
31. 5V
.50
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Date .
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Rece~ ~O l1 ,
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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
DATE TIME
CITY OF PRIOR LAKE 10 -10 )/30
INSPECTION NOTICE SCHEDULED
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ADDRESS /7 ~/ '3 w; k! -(.'" () ('55 (/'
OWNER CONTR.
PHONE NO. PERMIT NO. ~{
o FOOTING
o FOUNDA nON
o FRAMING
o INSULATION
yt=INAL
o SITE INSPECTION
o PLUMBING RI 0 EX/GRAD/FILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GAS LINE AIR TsT
,(rMECH FINAY-_..---o_ . ~_
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COMMENTS:
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jf"WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREC; :~K. CALL FOR REINsPECTION BEFORE COVERING
Inspector: /lrr (0 tD-()'- Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNOTl
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