HomeMy WebLinkAboutPlg Permit 02-1099
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CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File I PERMIT NO
2. Gold City . tJ2 - / 0 1~1 I
3_ Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
14473 s(}nr11 T
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ZONING (office use)
PUD
LEGAL DESCRIPTION (office use only)
LOT -71BLOCK I ADDITION .s I ~J&t4 AI 6 S.
PID 2j- so"] -tJ 71...-0
OWNER
(Name)
(Phone)
. (Address)
APPLICANT j J
(Name) /VlOIJ Ie- rI-/J1 (J 0 ~
(Address) /03 16 .2~q;tJ 4~
a (Address)
(Contact Person) r/l I/te 111 &Ov--e
APPLICANT SIGNATURE .o~ /)11~
WC1'fer
II,
(Phone)
Pr-IVI{.p~"
(City)
7b J- ]~q-70Y7
11111- 5~?7 /
(Zip Code)
(Phone)
DATE
q-~oz
Quantity
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)
Type of Fixture
I
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
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 # 02 - / (i 1 ~
PLUMBING PERMIT FEE $ 3 'I ,5 ()
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ 4 CJ. () (/
(Office Use Only)
This Application Becomes Your Building Permit When Approved
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Builtftng Official Date
Paid
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Date, ._
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Receipt No. d
'4 :lOft T-
By k
U
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
...r{ LAKE
,uN NOTICE
ADDRESS
I ~q 7 3
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED 1151D2. d-~
,S1!)1MVVl N .CI.VZ~
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
k 0 FIREPLACE FINAL
o Gt:t;E AIR TST
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JI WORK SATISFACTORY, PROCEED
~ORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~~
Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOfl