HomeMy WebLinkAboutPlg Permit 02-1233
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS
'3 8'10 (<{GA J
PASS
LEGAL DESCRIPTION (office use only) I
LOT /4 BLOCK } ADDITION 1(Jt}c-LF ~;JI
I t
APPLICANT /lA rL.'- j~ IlA /?L: I IA~ -,~ 7 "7 C 'J r; J
(Name) / VI O~ t y .rlO(JIr.,C wrr/CtIL- (Phone) /0 J - ..') Y I -a<..>;2
/tJ}3b ;"Jj9 n..~ ;(/0, /fr;;Cfff".! ~~7 7/
(Address) (City) (Zip Code)
(Contact Person) /J.if lIE jY! (j !!!-f (Phone) 7'J- ~ Y {, -0 { V F
APPLICANT SIGNATURE J'l~(/ DATE /tJ -;:;Z - IJ ~
APp.icfNT 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)
OWNER
(Name) _
(Address)
(Address)
Quantity
~,J S (VlIrN;J
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
(Office Use Only)
3-
I. Blue File
2 Gold City
3 Yellow Applicant
-)/3*
PID .~S - ,c3f?Io-QI4-,U
. (Phone)
Type of Fixture
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 #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved
Building Official
Date
39--50
.50
Lit) .
Paid
40 . - Receipt 49-t' & ()
!O -.J- -UJ.---By q:"/
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
CITY OF PRIOR LAKE
INSPr="'TION NOTICE
AlJDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
SCHEDULED
DATE TIME
/D-~-~ I1-T
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CONTR.
PERMIT NO.
u,;,- !.).3j
o PLUMBING RI 0 EXIGRADIFILLlNG
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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P'WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~O':::;'CALL FOR REINSPECTION BEFORE COVERING
f/ll/ 10"YO 7
Inspector: Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl