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~\.. CI; OF PRI~R LAKE
\5 INSPECTION NOTICE
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ADDRESS I 5 311
OWNER
PHONE NO.
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
COMMEiNTS:
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Inspector:
SCHEDULED
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DATE
TIME
CONTR.
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PERMIT NO. q q Act '-
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o EXC/GRAD/FILLING
o LKSHOREIWETLAND
o COMPLAINT
o SEPTIC FINAL
o FI~PLACE
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Owner/Contr:
THE NEXT INSPECTION 24 HOURS IN ADVANCE.
ENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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IJ.- ~LUMBING RI
I "\ ~ MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
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ECTION BEFORE COVERING
Tht' Ct'nlt'f or Iht' Lake Counlry
CITY OF PRIOR LAKE
PLUMBING PERMIT PP No.
APPIiCant:b~ Qt/~~ ({,,,. P~one: RC:,q-'lS~/
Address: 7 7.a(j-y:'~ ~,,:'-L- q._ G?~~~ tl1& ,~~~3
Signature: A:JiZl4~ ) ~/..~~
Legal Description: Lot>! / 'j' i. . I / Block .-"-"" Sub !,.' ,', I /;- 1/ d
Sit~ ~ddress: . /53:/. ""~ c:;~ r (':;~f~ . ,. / /' '
BUilding Permit #., .. /... cr PID # ' ~ ( (
NOTE: This permit will not be processed without complete information.
t. Btue
2. Gold
3. Yellow
Fite
City
Applicant
FIXTURE UNITS
Quantity
Type of Fixture
Quantity
Type of Fixture
Bath Tub with or without shower
Dishwasher
/
Rough-ins
Water Heater
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
C)
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
Floor Drain
Bar Sink
Water Closet (toilet)
FEE SCHEDULE
Industrial, Commercial & Multi-Family
(1 % of job cost, $39.50 minimum)
Residential, New One & Two Family
Residential, Additions & Alterations
State Surcharge
$99.50
$39.50
$
$
$.39..5'0
.50
$
GRAND TOTAL
$ '10.00
This permit is granted upon the express condition that said
contractor, shall comply rn all respects with (he ordinances
oLthe$tate ~Iumbing Code and the amendments U1ereof.
I: /') RECElryNO, c"/.' {// DATE
:L (, C' ATIEST
Call for all inspections 24 hours in advance.
16200 Eagle Creek Av. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
An Equal Opportunity Employer
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