HomeMy WebLinkAboutPlg Permit 01-0763
Date Rec'd
ell i OF PRIOR LAKE PLUMBING PERMII
OWNER G \) f
(Name) . q,ry ~0Y'Yl f\ en f'!3
(Address) 3~4~ \..vOOrL'~lAC~
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~~~ ACJ.<<J-;feJ ~{I.l,^,\~M.9
(Address) ? L '7 () 0 \)f-V\ e tf"ct ~ l
. (Address) ,
(Contact Person) ~ 0 M J-kJc.l..
APPLICANT SIGNATURE ~ ~
I
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)
(Please type or orint and si2ll at bottom)
ADDRESS ] 3 ~ r
WOOC.ut'c
LEGAL DESCRu-uON (office use only)
LOTbLOCK' ADDITION/, J~ '3rel
Quantity
I. Blue File
2, Gold City
3. Yellow Applicant
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PERMITt. 01- 07' 1-
~1;'"
'Z"$':y
t'!' ZONING (office use)
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,il"
PIDc:>s---a;31- ~ Cl
(Phone)
(phone) 9~2 'Ie, 9 --1If)f)f)
L.o.((eVI((e 0cH~
(City) C (Zip Code)
(Phone) \6 r2') '5 (p J- ~5'"O ~
7/23>1&/
DATE
Type of Fixture
~
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
31'50
_ .50
t(()JOQ
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Paid Lfo JO{ )
Dai"'~?>-o )
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Estimated Cost $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Building Permit #
$
$
$
\.,
ReceiY~/s7
By .~
DATE TIME
CITY OF PRIOR LAKE
INSPECTION'NOTICE
SCHEDULED
1-~7.;'&3
..
ADDRESS
\~3Iff I
PHONE NO.
PERMIT NO.
'7(3
(_ ti'~L.. t&7
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OWNER
CONTR.
...
o FOOTING
o FOUNDA nON
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
o PLUMBING RI 0 EXIGRADIFILLlNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
o MECH FINAL 0
t.aum ~flrK/Y-
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-
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORR T ~ CALL FOR REINSPECTION BEFORE COVERING
Inspecto:. I / Owner/Contr:
CODE 'EQUlREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
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