HomeMy WebLinkAboutPlumbing Permit 03-0804
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
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ADDRESS
'/0 ~5' 15L(Q"-
OWNER
CONTR.
PHONE NO.
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PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTI 0 MECH FINAL 0
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o PLUMBING RI
o MECH RI
o WATER HOOKUP
o S
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
COMMENT.
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o WORK SATISFACTORY, PROCEED
o 9PRRECT ACTION AND PROCEED
V CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: A~ Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
/f'ISNOTI
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
(Please type or orint and,~ign at bottom)
ADDRESS I ~/~r;GD(Offi"U")
11055 151..\ """ 5~. VY,^-o
;~: ~:~ I PERl\1u NU'/'\3_ 0/\/ j I
J, Yellow Applicant U C)'-^-;I'
LEGAL DESCRIPTION (office use only)
LOT;) BLOCK $ ADDITION
OWNER
(Name)
\) 0\ J. Or L.e...h L
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tJ/ttt.P 11lkR PID;;?5--,;J3b- Gig,)
_ (Phone) qf)8 -440 '?llD
(Address)
'APPLICANT t'\. --' ~ C
(Name) I.JU'\..V\~S \Nt' Q (Phone) LPld - DOl" ~-:4lo/)
(Address) lo 14 ?/~ I\Vt ~
(Address) , (City) (Zip Code)
(Contact Person) \J~ (Phone) ~
'PLICANT SIGNATURE ~ \. ~~ DATE
APPLICANT PLUSE COMPLETE BELOW
Quantity I Type of Fixture I Quantity I Type of Fixture
I Bath Tub with or without shower I I Rough-ins
Dishwasher Water Heater
I Floor Drain I Water Softner
I Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
I Laundry Tray (1 or 2 compartment sink Sewage Ejector
I Shower Stall \ Backtlow Assembly
I Sinks I BackfIow Assembly Test
I Bar Sink i Lawn Sprinkler
I Water Closet (Toilet) I Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Estimated Cost $
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Residential, New One & Two-Family $99_50
Residential. Additions & Alterations $39.50
Building Permit #
_10ffice Use Only)
-his Application Becomes Your Building Permit When Approved
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
'69.50
_50
L-\U. DO
Building Official
Date
pai~ '-Ii). -
Dat%~ /q<3
- ReceiP~4'f(ol.f
_ By <1 C-
O
24 hour notice for all iuspections (952) 447-9850, fax (952) 447-4245
t6200 Eagle Creek Ave.. S.E.. Prior Lake. MN 55372-1714