HomeMy WebLinkAboutPLMBG 08-0578
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS ILl qq;:l
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
SCHEDULED
8jfOB
TIME
~~\",^'<; ~[\'
CONTR.
PERMIT NO. ~ -t:; r;;;,
~UMBING RI ...... 0 EX/GRAD/FILLING
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE RI
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GAS LINE AIR TST
o MECH FINAL 0
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t:-WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o eORRE?;.f.}cALL FOR REINSFEeTION BEFORE COVERING
Inspector: I 4 ~ Owner/Contr:
\J U /
CALL 447-9S5B"FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE R~EMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTl
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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(Please type or print and sign at bottom)
ADDRESS
P-!C/92 ,,~-b~r{j16 /-, r r'_~_
I. Blue File I PERMIT NO I
; ~:~w ~~~licanl . O?, (:5 7 f.
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ZONING (office
use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
D")'1 y;>,
lfl?fL" Y\ lAJ
/'-1112 (Y~(!Jl~~ 6'r//e < J.E
(Phone) q62- J.jJj~ - ~73
(Address)
APPLICANT SIGNATURE
~~~~~~ANT ;J/6.~kmp~jyl~ )J/ ~J./
(Address) //;,)/7 L,/P!YJ//t';')' R/)
(Address)
~j)iI1) '-;;; Il~,
< -
/ ////
/-"7 c-- . "
//~~/o~c/& DATE :B~.,6-/p)
L' <..\PPLICANT PLEASE COMPLETE BELOW
Type of Fixture I Quantity
Bath Tub with or without shower I
Dishwasher I
I Floor Drain I
I Lavatory (Bathroom Sink) I
I Laundry Tray (1 or 2 compartment sink I
I Shower Stall I
I Sinks I
I Bar Sink I
I Water Closet (Toilet) I
FEE SCHED ULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
(Phone)
~G---\.A )
\. (City)
hC)/- ~~~ -#/~~
,J:/l/2/
(Zip Code)
(Contact Person)
(Phone)
Quantity
Type of Fixtu re
J
Rough-ins
Water Heater
Water Softner
I Stand Pipe (Washing Machine)
I Sewage Eiector
I Backflow Assembly
I Backflow Assembly Test
I Lawn Sprinkler
I Other
(Office Use Only)
Estimated Cost $ J, ~') Building Permit #
PLUMBING PERMIT FEE $ <\c;. ,~G-> ~j-<j ~7.'
STATE SURCHARGE $ .50 . ~-()
TOTAL PERMIT FEE $ Jp, r oJ,-... S7'. (/l
Residential, New One & Two-Family $99,50
Residential, Additions & Alterations $39,50
This Application Becomes Your Building Permit When Approved
BuUdinl! Official
Date
Paid r. {' C' C'
J ,. I
Date ,% (,. I. (
L/'. .' ..L (./
Receipt No.
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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