HomeMy WebLinkAboutLA027209 PERMIT
CITY:OF LAKEVILLE PERMIT TYPE:
201,95 HOLYOKE AVE. P.O. BOX 957
Permit Number:
Lakeville, Minnesota 55044-8012 Date Issued: t7¢t~
(612) 469-4431
SITE ADDRESS:
1 ~i~~~ ~RYSTA.T. B I LT~S LA.
Lt~T : T. BL~GTC : 1
t:,RYSTA L LAI~F GQT.F ESTATES?.ND ADD T T t t~N
DESCRIPTION:
` G 4 III, FDF I ~3SFEGT I Q~i
Pltun~i ng P~rm3 t Type WATEE SnFTF:NER
Plumbi.n~ W~ark Type ADDITICI~
1 WATER .Sf?FTENER
REMARKS:
FEE SUMMARY:
Ba ~A FQQ $ ~ ..~.~i
Sur>.r,h~.rgP _ 50
Total. Fee _ $2t~t~Q
' CONTRACTOR: - Apt l.can:t - OWNER:
t;TJLI~ I ~ AN AT N~RTHF I EL,D ~3~ BAtJ~[Al:~ FAT
1 ~ 3 W STTI ST Ft~ B~~ 35C~ I.~C~~Q t;FXSTAL T€ T LL~S TEA
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I HF.RFF~ At~RFF: THAT T HF Wt;.~RI~ Ft~F. i~H I t.::H T H I ~ PERT3I T I S I SST3ED SHA I,I., RE I='ER-
F>?RA(I?.D AG~:nRI~ i NG TO : t } > THE A FFRf1~1F.D :E'I_,A ~S A NP SFF.t~, I F I ~ AT I ONS ; THE
~ AFFL 1 CARLF' c T TY t"?FD I A~ANCFS , AI~I? t.,01)FS ; A~+D p t r~ ~ THE: I~T~ STATE BtI I I,I?I I~G C~7Dfi .
ISSUED BY: SIGNATURE
PLUMBING FERMIT APPLICATION
4 CITY OF LAKEVTLLE
BUILDING INSPECTION DEPARTMENT
20195 HOLYOKE AVENUE, P. O. BOX 957
LAKEVILLE, MINNESOTA 55044
- (612) 469-4431
DATE • ~4 ~ ~ 4"
JOB SITE ADDRESS : ~ ~ ~ ~ ~r ~ ~-~-~_-~_~~l ~^'-PID#
LEGAL DESCRIPTION: LOT: ( BLOCK: SUBDIVISION: ~ ~
APPLICANT:.. OWNE OR~O~dTR~CTOR (circle one) f~'c~"~~~C/ ~
OWNER R BUILDER: ~~-~5 ~a-~+-~ ~ ~ PHONE: g~ 1 3~ 3l
STREET ADDRESS: tt_~`aJ ~,r~s~L1~.~,~~ CITY: Lakeville ZIP: 55044
1..-~~
PLUMBING CONTRACTOR: CULLIGAN CONTR. NO.y~~ PHONE: 333-7577
STREET ADDRESS: 113 W. 5th CITY: Nnrhhfici~ ZIP:SKn~,? _
NEW CONSTRUCTION OR EXISTIN (circle one)
PLUMBING SYSTEM (21): SOFTENER (22):x_ SPRINKLER (23):
STANDPIPE (24): LAWN SPRINKLER (25): INSIDE PLMBG CONV (26):
REPAIR OR REMODEL (27): WATER HEATER (28): MISCELLANEOUS(30):
`~~~t-FOR: RESIDENTIAL: X COMMERCIAL: INDUSTRIAL:
V JOB COST: (TO BE COMPLETED FOR COMMERCIAL & SPRINKLER SYSTEMS)
PLUMBING FIXTURES: (Indicate the number of fixtures installed)
WATER CLOSET (Ol) SLOP SINK (12)
LAVATORY (02) 1 WATER SOFTENER (13)
DISHWASHER (03) URINAL (14)
SHOWER (04) DISPOSAL (15)
BATHTUB (05) RAIN LEADER (16)
WASHER (06) CATCH BASIN (17)
LAUNDRY TUB (07) SUMP PUMP (18)
KITCHEN SINK (08) OTHER (19)
CLOTHES WASHER (09) ROUGH-INS (22)
FLOOR DRAIN (10) WATER HEATER (23)
DRINKING FOUNTAIN (11)
Applicant's Signature: DATE:
PLUMBING FEE RATES:
Residential: Commercial:
New Construction: $50.00 1~ of contract cost + surcharge
(49.50 + .50 surcharge). (contract valuation x .0005)
(INCLUDES SPRINKLER SYSTEMS)
Repairs or Remodel: $30.00
(29.50 + .50 surcharge) Minimum of $30.00 (29.50 + .50
surcharge)
Water softene $20.00
(19.50 + .50 surcharge) .
PLUMBING PERMIT APPLICATION PAGE 2
OFFICE USE
SYSTEM TYPE: METER;
N (81) SIZE
ADDITION (82) TYPE
REPAIR (83) SERIAL
DEMOLISH (84)
REPLACE (85) INSPECTIONS:
ALTER/REMODEL (86) R UGH-IN (64)
MOVE 87
( ) FINAL (65)
(70j
PERMIT FEE:
~~r
PERMIT FEE: $
SURCHARGE: $
METER: $
REDUCING VALVE: $
OTHER: $
TOTAL : $ ~
I f J
~ C
APPROVED BY : ` ~ ~a-L' ~ -C;~
~c:.,,~, DATE