HomeMy WebLinkAboutPlg Permit 02-1232
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I, Blue File PERMIT NO
2, Gold City .1./) _) t'.'\. ~ ~ _
3 Yellow Applicant ~::r J
(Please type or print and sign at bottom)
ADDRESS
3 8' ~~ f<~GA I
f!r5J
LEGAL DESCRIPTION (office use only)
LOT 8' BLOCK / ADDITION ~t(ajJ ~.AV!-
L.It rJ 5 ;11 Il-N' ~
PID ,'J.S- 3'?b-oof-O
OWNER
(Name)
(Phone)
(Address)
APPLICANT SIGNATURE
1~~;~~ANT /14 DolLe -r MOD 1Ze tJfHttl T/IE~e) 7 {, "3 . Y~9 - ;2J,z J
(Address) /(J lIb ,^-9?T( lWE A/4, fJl(wct:-kt1l ">sY7!
(Address) (City) (Zip Code)
(Contact Person) .f;f(f ;/{/l41lC (Phone) /65 -;236 -0 I <IS-
4-/)cfd' DATE /tl -.2-& 2-
6;LIC~N~ P~EASE ~OMPLETE BELOW---
Type of Fixture Quantity
Bath Tub with or without shower
I Dishwasher
I Floor Drain
I Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
Quantity
Type of Fixture
4.
Rough-ins
Water Heater
I Water Softner
I Stand Pipe (Washing Machine)
I Sewage Ejector
I Backflow Assembly
I Backflow Assembly Test
I Lawn Sprinkler
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 $
a q-SD
.50
/-f () .
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
. Paid ,
'10,----'
Date ."
/0',::)-0 d-
. Receipt 1';J'g. 0-' ;\
J,.jf()(vu
By
.
QC/
fl
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
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULEoI6,9 -0 d-- /T I
,;j,f>~.- R-e~tf N,c s/
j
CONTR.
PERMIT NO.
/) ,r - Id:se;-
e.
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 MEC~)JAL D~_
P2!O;~~ ([)
.t
{ ~l*Y
q.,.
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~WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
1/1 A/?! 0 J" d2--
Inspector: j!j,[f E ,- Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lIISNOTl