HomeMy WebLinkAboutPLUMBING 08-0184
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
IG447
JT.:t\~ u
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
~INAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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COMMENTS:
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DATE TIME
5-('00
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o EXIGRAD/FILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
t WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WO~K~A~ REINSPECTION BEFORE COVERING
Inspector: /fV r'" Owner/Contr:
,
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or print and si~ at bottom)
ADDRESS IL it') - ZONING (office use)
i0itfl ]ilScl1 /1\fG Sf
I. Blue File PERMIT NO
2. Gold City . 08. O/~A _
3. Yellow Applicant Il}'f-
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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OWNER [;,- ~. I { (' ~ . I \ .
(Name) L-Q) Il ~~ \ 0 ,
(Address) E)ct'~l Q J
(Phone) .0 \ 2- 9 (6/- ~U,O
-ThorlLl\(Q, N\~. Cf5 31 d-
o 0 .
APPLICANT
(Name)
Champion
651-365-1340
3670 Dodd Rd. #100
t:agan, ~N~~~-1339 (City)
(Contact Person) 0\ sf) I eh (Phone)
APPLICANT SIGNATIJRE ~~~EASE COMPLETE B:::W
Quantity Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
I Laundry Tray (lor 2 compartment sink
I Shower Stall
I Sinks
I Bar Sink
I Water Closet (Toilet)
(Phone)
(Address)
(Zip Code)
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 I % 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 $
LtO c
'T!''.)O
.50
!?() 0 oiL
(Office Use Only)
Building Official
Date
Paid 5"0. 0 0
Datet} .1.,,1,,;' rib ·
eipt N05,5;S"11
Y
This 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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