HomeMy WebLinkAboutPlumbing 03-0784
DATE nME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED 7--1-s
ADDRESS IG41'1 ~--~f<;
OWNER CONTR.
PHONE NO. PERMIT NO. -:J-7~
o FOOTING o PLUMBING RI o EXIGRAD/FILLING
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: f1hJ t.k (,L-k...-
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----.....
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~ WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
\ JW1 7--1 ~~(f)
Inspector: V' /I' Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH &: SAFETY!
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CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3_ Yellow Applicant
I PERMIT NO. 03/ t7 8Lf
(Please type or print and sign at bottom)
ADDRESS /6/ jq,/
7 /7 Fi v'e i-I t)A)j/{s l}vlA1ue S.~,
f<NING (office use)
'l-SD
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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,
PIDhl, 5"'-/ X' 3-0Ir-,
OWNER ~ _. , T'\
(Name)~E?/YSoYJ , L/aA/I'oI
,
(Address) /&,491 Ft've H auJ/(s Ave. 5. E.
APPLICANTAj L / _ '1""\ l
(Name) OY f..ljgYY1 ~ J lJ/YYJ Dill C(
(Address) 290S- tfJu-i, e Id Ave. g".
(Address)
(Phone) '<t5l J 1,/0 - ftJ2tf!"
(Phone)
Mp\s
(City)
((o\Z)827- 'I~33
55"Lj 0 'F
(Zip Code)
(Contact Person)
l'PLICANTSIGNATURE ~~
- ~
(Phone)
--
DATE
(,~ftJ
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
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 Penn it #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3<1. Q)
.50
QO .00
(Office Use Only)
~_L This Application Becomes Your Building Permit When Approved
Building Official
Date
pai~ tjt),-
Date~ ~ lro - 3
Recet rt~oi)
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714