HomeMy WebLinkAboutPlg Permit 01-1076
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
1. Blue File
2. Gold City
3. Yellow Applicant
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(Please type or print and si2I1 at bottom)
ADDRESS
I f4 eS I Pt;;~JZ,1 Al6 ()I t2.
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ~Or-Oz'r-o
OWNER
(Name)
(Phone)
(Address)
- -
~APPLICANV j ....fI(
-warne) v-v
6-0 ( d.-~~l (Phone) t./40 - ff 0 '7..1
ff~ n'l\L ~~ fJMJv-~
(Address~ (City)
(Contact Person) -~ :-- (Phone)
\~.PPLICANT SIGNATU~ t!9.~~ ~ATE
r ~ ~ f
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture I Quantity
Bath Tub with or without shower I
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
(Address)
1l;,8"Sl
;::;s < ~ 7)-
(Zip Code)
Q-;l7-o I
Quantity
Type of Fixture
y
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
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
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit # A 1-107 t,
3 q. S7J
.50
4-0. (J ()
$
$
$
Estimated Cost $
(Office Use Only)
This AP~~ ~BecomesYJ!ur Building Permit When Approved
~~ 1,~7"OI
Building Official Date
Paid +d. (1)
Date
1"'Z-1,o/
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
ADDRESS
16!~1
DATE TIME
SCHEDULED /tr30-tJ{ d .'07..:J
p~~'~.
U
CONTR.
CITY OF PRIOR LAKE
INSPEJTION NOTICE
OWNER
PHONE NO.
PERMIT NO.
1-lo7b
o FOOTING 0 PLUMBING RI
o FOUNDATION (f) 0 MECH RI
o FRAMING 0 WATER HOOKUP
o INSULATION 0 SEWER HOOKUP
liIJ FINAL 0 PLUMBING FINAL
/6 SITE INSPECT N 0 MECH FINAL
COMMENTS: K.,lt~~. Ula.rJ1 S;o/l.-R}~
:;,::&tt~'
~~O
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
~
)4 WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
~(
. r \
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
Inspector:
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
INS/lOTI