HomeMy WebLinkAboutPlg Permit 02-1095
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO
2 Gold City . /'l '\ _ J /J '/.... .r-'
3 Yellow Applicant l-/c:::::^ IVJ
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
5430 t"Y', \ \-u-s C\ rc..\e 5cr\A.~e'^-st R'
LEGAL DESCRIPTION (office use only)
LOT 3 BLOCK / ADDITION
r
c9-~
PID JS "'0 f 8-()O 3--0
~
OWNER
(Name)
.. _\(LLobs-elY\ J -:Ph- \ \ \ ,6
5130 (V)", II-vrs Ci ('c\ ~ $. {;. .
(Phone) (QS2) l.ft.{7- g777
. (Address)
APPLICANT ~ \ L\ "8 \ \
(Name) I'JO\O om \ lMMt\\(\~
(Address) 2105 tnlLYt: e lei Avena!e S:ru..&
(Address)
(Phone) ((,12.) '8 Z 7 - L{o 3,3
Mp\s 55108
(City) (Zip Code)
(Contact Person)
APPLICANT SIGNATURE ~~---...
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity I Type of Fixture
Bath Tub with or without shower I Rough-ins
Dishwasher \ Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks I Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
(Phone)
DATE
l? /2'/02.
Quantity
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 $ .y~ ~
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
31, 50
,50
'-/0.00
(Office Use Only)
Date
Paid Ij(j /___
I Date 9 - '-/- 00
Receipt No.
This Application Becomes Your Building Permit When Approved
Building Official
,B~
f/
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 @
] INSULATION ~'
if FINAL f'"
/ ] SITE INSPEC . UI~
COMMENTS:
/J{1
DATE TIME
SCHEDULED
f;, ifC) -;;;;- //:d?J
5930 /fIf 1!eI~ tZvu
CONTR.
PERMIT NO.
J- /Of:J)"
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 GASLlNE AIR TST
o MECH FINAL 0
Willi- 1'()~AJXJl~
J.fJ) 1Lf~0
(/
(!f~ ~~
5JJ-!f- phtJ J It'S
f/i./7- ??777
~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ~/ ( Owner/Contr:
CALL 44;~~0 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
II'/SI'/OTI