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C,ITY..OF PRIOR LAKE
- INSPECTION NOTICE
ADDRESS J 1./ if :3 5
OWNER
PHONE NO.
o FOOTING
o FRAMING
o INSULATION
o FINAL
o FOUNDATION
o DEMOLITION
o FIRE PREVo
COMMENTS: t.J A kA-
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SCHEDULED
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CONTR.
PERMIT NO.
~LUMBING RI ~
6 MECHANICAL
o WATER HOOKUP
o SEWER HOOKUP
o SEPTIC INSTALL
o PLUMBING FINAL
o SITE INSPECTION
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DATE TIME
3- S - &f'i
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o EXC/GRAD/FILLlNG
o LKSHOREIWETLAND
o COMPLAINT
o SEPTIC FINAL
o FIREPLACE
o
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. CALL 'OR REINSPECTION BEFORE COVERING
Inspector:
Owner/Contr:
30 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
lREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
CITY OF PRIOR LAKE t ;~L ~:licant
PLUMBING PERMIT # qq - /1.. \1
Applicant.c J;~ l"YLukAt)C ~( Phone: .tJ~t1~g/A.?/
Address: /k. -:.KL~ I//:~,~~; 7~ ?-rIA!- _<::5' ~ L.
Signature: ./J74-7 ~~ ...<Y~c;.~~/!: .
Legal Description: Lot I . BI~Ck / j9ub n't; I/;(j../f~ 14-r-~c4
Site Address: _/~9Y~ uh/cLs ~rL/d.e2~ .
Building Permit # PID # 't- 5--3& .wl - I
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
Thr Cf'nter of the Lake Country
Quantity
Type of Fixture
Quantity
Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
/
,
Rough-ins
Water Heater
Water Softner
Stand Pipe (washing machine)
Sewage Ejector
Backflow Assembly (RPZ, Double Check, PVB)
Backflow Assembly Test
Lawn Sprinkler
Other
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks
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
$
$
$ :?l- 5D
$ .50
$ Ytfr OV
GRAND TOTAL
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of t~,e State Plumbing Code and the a~erdmentrthereof.
.::>4(~1 RECEIPT NO. "2 "?'1/~DATE
~I//.I- . ArrEST
,
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