HomeMy WebLinkAboutPlumbing Permit 04-0501
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f~~ CITY OF PRIOR LAKE PLUMBING PERMIT
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J I ~ 3. Yellow Applicant PERMIT NOtJL/_ .501
Date Rec'd
(Please type or print and sign at bottom)
ADDRESS~ '/ ,J J f) J
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G/-. IV W
ZONING (office use)
LEGAL DESCRIPTION (office use only) a .. r rf2J..
LOT 1 BLOCK I ADDITION A~11/J#r a;t--/k (JJdm;;?5-?;03-{Y):'7-()
OWNER ~ h ....-l II ~ - g
(Name) ~ I CJ ~PL~ r-ra/JS~h (Phone) '19/?- 3(){Po
(Address) 30 g" WI/tis R'df<- et AI W .,o~
APPLICANT JA 1''' r
(Name) r ( 'L~ ttJ~..f- ~ (/1'1 I
(Address) ltJ() {'". /2-IA. f}j)~ S
o J_ (~ddress) . (City) (Zip Code)
(Contact Person) fC-tYJe A)- _:J a ''3:-r. 1'1 (phone) CK2 -~ j/-I? {; 7 t:.
(' "PLICANTSIGNATURE :::/ ,- DATE JJIZ/f) 'I
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~PLIC~ PLEASE COMPLETE BELOW' . ,
Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins _ .
Dishwasher I Water Heater S () S ~ ,I
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 com pal ~lUent sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
(Phone) 9S'Z-t:Jjl- 91fl7~
Quantity
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Vii
Estimated Cost $ 7 rI () ----
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERlVll1 FEE
$
$
$
1/0 d ~ fJ!iy/~
(Office Use Only)
.~ fhis Application Becomes Your Building Permit When Approved
Paid
Date
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5-~-tf
ReceiPtLl6 f g.b
By t;L -
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Building Official
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
INSPECTION NonCE
ADDRESS ~~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED &,-J -0 'I
LUII.&sR~ (Jf.
CONTR.
PERMIT NO. '/-5?/
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
)ZlPLUMBING FINAL
o MECH FINAL cJdIr
~
o EXlGRADIFILUNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
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~WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ' I) Owner/Contr:
CALXJ.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE JQUlREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYI
INSNOn