HomeMy WebLinkAboutPlg Permit 04-0487
Date Rec'd
ell i OF PRIOR LAKE PLUMBING PERNUI
REQUEST FOR FINAL
INSPECTION SENT TO
. (please type or print and sign at bottom) HOME 0 WNER 01-05
ADDRESS
50 '-/9 'iI~ U AE
~~ ~:;y PERMIT NO. O[f' _ I. / if). /)
rellow Applicant L-ft\ II
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT to BLOCK ( ADDITION {) /j leu )(Y) d
ctJJk ~ 0
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PIDc9S-0d-..6- 0 O~? 0
OWNE~
(Name) t1t'LIJ.IL.U
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(Address) 5 ~ tjq t:i ..uJJ-l.A"J-4I.) ~ ..4 ~
(Phone) 9_'5.2. -.4:L1e -....i I '75
<fJ~Y~_, CfJ1n, 553'l~
~~~~~ANT W c,o ~X1.uJ~ (phone) 1-5/- ~~ k 5 ~ I ~ '11J
(Address) 3~?CJ ~ cRJ, ~~) . VIlfL _tf..t) /.i3
(Address) , (City) (Zip Code)
(Contact Person) Vn OLrV ,c; t"'c\l e I1n"l (Phone) /,., C\ / - ,.:~ It;, 5 - 1;3 J...fD
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PPLICANT SIGNATURE '--/Jt1'PhL!- LJ:;LLL~ DATE _Jj' - / ~ -- CJ t./
,
APPLICANT PLEASE COMPLETE BELOW
Quantity I Type of Fixture Quantity I Type of Fixture
I Bath Tub with or without shower I Rough-ins
. Dishwasher I I Water Heater
Floor Drain I Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall I Backflow Assembly
I Sinks I Backflow 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 Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ ~-1 ~ c (ffl
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
39,56
.50
"Y'O, a-(5)-
._~ (Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Pa~d 110. --
Datec '"""",:} tj- 2-/
-"
, Rece~z,R:j4
B ~ - ,
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
Jf PRIOR LAKE
...SPECTION NOTICE
SCHEDULED
dyoV\-
ADDRESS
~'i7
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
..eJ'1i[UMBING FINAL
o MECH FINAL
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMME~;1 /
~ J/#?C e!d
/
DATE TIME
~~~
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. il I1 ~/l
o EXlGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
o
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ftRK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORKJ.C~ r:.Jl REINSPECTION BEFORE COVERING
Inspector: fr1 ~ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYI
1/fSNOTI