HomeMy WebLinkAboutPlg Permit 02-1238
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
1lo;).-a\ ~CU/(\J\(Uj tV.
I. Blue File PERMIT NO
2. Gold City /-J" . _ (13 c::'
3, Yellow Applicant ( J 7- ___ 0
NING (office use)
PIA!)
LEGAL DESCRIPTION (office use only)
LOT t BLOCK ( .::; ADDITION
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PID ;}5 ... ;}11' I) 3]- 0
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OWNER
(Name)
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(Address)
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(Phone)
(Address)
I APPLICANT
(Name)
(Address)
(Phone) {~\d' ~ \ - 5~Lo ()
L\t'll.\"j/\O ~V\_ 661~ \ 1-
(City) (Zip Code)
~
(Phone)
(Contact Person)
APPLICANT SIGNATURE
DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture I Quantity Type of Fixture
Bath Tub with or without shower I Rough-ins
I Dishwasher I I Water Heater
I Floor Drain I I Water Softner
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundry Tray (1 or 2 compartment sink I Sewage Ejector
I Shower Stall I I Backflow Assembly
I Sinks I I Backflow Assembly Test
I Bar Sink I:\. I Lawn Sprinkler
I Water Closet (Toilet) I I 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 $
39,56
.50
40,'-
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid J!lo ,00
Date /rJ 'l~-o-
Rece~t.NOC.. I ~
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BY~
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED 4-- Ib -_3
10~~1 PMku~~
CONTR.
PERMIT NO.
~ - I ;;;-3g
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
o MECH FINAL 0
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~ SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: JILr Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEAL TH & SAFETY!
I/VSNOTJ