HomeMy WebLinkAboutPlumbing 03-0872
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AOF PRIOR LAKE
./INSPECTION NOTICE
DATE TIME
ADDRESS
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SCHEDULED ~Y-O<
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OWNER
CONTR.
PHONE NO.
PERMIT NO.
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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 EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
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COMMENTS:
~
/
~ SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT. 0 CALL FOR REINSPECTION BEFORE COVERING
Inspector'
Owner/Contr:
7- 8 0 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
EQUlREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO ~
2. Gold City . A.;2:_ () 1'\.
3 Yellow Applicant C/ .:./ IT J
(Please type or print and sign at bottom)
ADDRESS
)6d-CJI /} /W ;;044/.
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ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT { BLOCK 6ADDITION~/1/')tA/l-' ,/.s:r-
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PID;?S"-31t:,- lJr3-'t'-"d
(Phone)
I (Address)
APPLICA~T
(Name) -tt!...._~
(Address) 4~
LJ.'eu :LA
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k~~ Utt.u-t"u RDA-D 81' ..J,(M)f, t::. ..1''-1
(Address) (City)
(Contact Person) A~_ 1.-J:74'~ _ (Phone)
lPLICANT SIGNATUR~ (j.J ~.../ ~A-' Q DATE 9-- 1- 0 "5
-AP~LIC~J~T ;L~ETE 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)
(Phone) .r.; (2.. qf-. ( . s'lifO
sD 5?-:J (6
(Zip Code)
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
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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
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
Building Permit #
3Q50
$
$
$
.50
I{O.'--
I Paid Llo..-
Date 11,....- /-- 3
Ret1t1f,37
V
Estimated Cost $
.-lQffice Use Only)
his Application Becomes Your Building Permit When Approved
L
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714