HomeMy WebLinkAboutPlumbing 03-0818
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHED,ULED ," .1.:;-03
ADDRESS '2.8Ct;,< ~\o~
OWNER CONTR.
PHONE NO.
PERMIT NO.
~ ,.- SiR
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
~ GASLlNE AIR TST I ,_
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COMMENTS:
/
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORP~~ORK' CALL FOR REINSPECTION BEFORE COVERING
'''pecto ~ i~ Owoe,'Con"
CALl: 44f-JsO FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
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CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETYl
INSNOTI
.-. -'''''-;--'-. .-.-.--.---.----..
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO i1
2. Gold City . AJ ...::J - 01.
3 Yellow Applicant (f / -a 0 I
(Please type or print and sign at bottom)
ADDRESS
OJ.. 8' /; S
I>>-h{!a-f 4~
ZONING (office use)
12/
LEGAL DESCRIPTION (office use only)
LOT ro BLOCK 3 ADDITION (~ "'~ uP--.
PI05'- 3g~- O~~-O
J
OWNER
(Name)
The r b r f) Dk.-<-
Cc-,)) .
(Phone)
(Address)
'PLICANT SIGNATURE
(Phone) 9)~ {7J S-G. '] ~
+c.9 ~ IJ..> r rY2 '(3
(City) (Zip Code)
(Phone) _ (p~ 2:2(- ~JY:S
~/Z~ 7
DATE
APPLICANT Le-c ~ ,ak~.4 .# t~. - .~ 1'..,1,", 5
(N ame) r ".:r
:;t 0 'S - (~ frv-L f'-J
(Address)
(Contact Person) L.a- J '""\ D v 0 11
(Address)
Quantity
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)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
x-
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 $
~q-SO
.50
tfo...
.10ffice Use Only)
Building Official
Date
Paid I /.
t{'()... -
Date
&, - d-O.-() 3
Receipt No.
'his Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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