HomeMy WebLinkAboutPlumbing 03-0867
DATE TIME
CITY OF PRIOR LAKE '7-//
INSPECTION NonCE SCHEDULED
ADDRESS S"L{JO ~u, !l,l
OWNER CONTR.
PHONE NO. PERMIT NO. :7-?C7
o FOOTING o PLUMBING RI o EXIGRADIFILLlNG
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS: ffj- 0 H't't( I--
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~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT ~O~LL FOR REINSPECTION BEFORE COVERING
Inspector: -f-1-I- Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY I
lNSNOTI
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3, Yellow Applicant
PERMIT NO.()-3 -- 9' bl7
(Please type or print and sign at bottom)
ADDRESS
5130
(VI tu1o-r 7<0 ad Sc/U,i!t ~
ZONING (office use)
LEGAL DESCRIPTION (office use only) U. < 111 4
LO~ BLOCK ~ ADDITION (7)~ vi1 {VJ1(Jl> ex .
PID15'611D ooqo
OWNER"" '"lL \
(Name) t .kuJi.s. I L):Mr ()a.IV"C\.
(Address) 5'-/30 fVllVYJP'f' I<d. Seo,
(Phone)
('lsz) '117,3'1710
APPLICANT .. \ L \ () to
(Name) 1'-' 0 .. 01 O^wl "\ l\J.Ad\A IV'\.!:.
(Address) 2105 ~~-4e.jd Ave\6o.
(Address)
(Phone)
Mp\s
(City)
(loll) 827 - 1033
55L/08
(Zip Code)
(Contact Person) (Phone)
JPLICANTSIGNATURE ~~~ DATE
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)
t,/Z3!tJ3
Quantity
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
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 $
3'1.50
.50
'f0. ()O
.-'Office Use Only)
Building Official
Date
Paid '1-1- '3 ReceiPLlLjR3~
Datetj () , _____ --By em...)
fhis Application Becomes Your Building Permit When Approved
i/
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714