HomeMy WebLinkAboutPlg Permit 05-0061
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
I ~ I q. () S-
I. Blue File I PERMIT NO I
2. Gold City .().I c- _ 0 0 / - I
3 Yellow Applicant U - lP
<'lease type or print and si~ at bottom)
ADDRESS
~
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
ADDITION
BLOCK
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(Phone) ();!5/)-fq /./ { 64-
OvrNER . .
(Name) ~aJJJ O,c,t--II-e--
(Address) (c..a VYlf'./ IA ~ (J. ~~
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(Contact Person) ~ 1 (Phone)
APPLICANT SIGNATURE #WA-.Jl1J-_ (lYl DATE
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)
APPLICANT
(Name)
(Address)
Quantity
CULLIGAN WATER CONDITIONING
0036-CULUGAN'I,,',","
MINNETONKA, MN 55345
(Address)(:152) 933.1200
(Phone)
(City)
(Zip Code)
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, .
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backtlow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39,50 minimum
00
Estimated Cost $ ?DO-
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Building Permit # (J s-. {JO& I
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ '-3q .50
$ .50
$4-0.00
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Receipt No. -'Fgt..5:3
By
Building Official
Date
Paid 40. UV
Date;. V),OS-
AfU
I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
DATE TIME
CITY OF PRIOR LAKE , / /
INSPECTION NOTICE SCHEDULED.L / " / O-S-
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""
ADDRESS
OWNER
CONTR.
PHONE NO.
PERMIT NO.
~-c/
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
.r;tI l?J.,.UMBING FINAL
o MECH FINAL
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS: .l /'
U/e;7?r
r' ;'//
o CJ T~~e'--
./
/
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~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK~ ~~ ';~ECTION BEFORE COVERING
Inspector: ./ ym Owner/Contr.
, ,
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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