HomeMy WebLinkAboutPlg Permit 01-0688
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3. Yellow Applicant
NING (office use)
PM
(Please type or print and sign at bottom)
ADDRESS
3UlJ
W~od \)Uck' \)~,
LEGAL DESCRIPTION (office use only)
LOT d./:toLOCK ( ADDITION
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PIndS' -~3?-O~~-()
OWNER /'
(Name) l ~ G\' Y
(Address) j ~*4 ,. lNoo J Du ~~ Of" .
~~~;~~ANT llLCJ'C?liteJ ~ lU-M~~
2 L 7[){J O~eirac<1
(Address)'
(Contact Person) To YV\ r/--ov"'--
APPLICANT SIGNATURE ~ /~
Wi ~r S
(Phone)
(Address)
(Phone) 95"2 S"c, 9- {,/OCJcJ
ctJlfGJlf ~O</q
. (City) - (Zip Code)
~(2 Sq?- ~,oy
'7 - /0- CJ I
(Phone)
DATE
,
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink I Lawn Sprinkler
. Water Closet (Toilet) 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 $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
2)9,5"0
.5Q
41).00
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 7-/ () -0 I
Da~L(Ot 00
Rece~ ~r;rq S-
BY~
U
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED /'-d-'1'V
(~yRL/ ~~
CONTR.
PERMIT NO.
t --~ ?~
o PLUMBING RI 0 EX/GRAD/FILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
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~ORK SATISFACTORY, PROCEED
o CORR~T ACTI ND PROCEED
o CORRtCT W K, FOR REINSPECTION BEFORE COVERING
Inspector: \ Owner/Contr:
CAL~J7-9 .~) FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
\ I ,
CODE,,\ ':QUl EMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl