HomeMy WebLinkAboutPlumbing 03-0186
gq c-j
~'.j Wl"IA. l(...~~
CONTR.
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS 1- ~3 ~......
OWNER
PHONE NO.
PERMIT NO.
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
COMMENTS:
OATE TIMe
~.; '~(41
o EXlGRADIFILUNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR TST
~
/
.,rv;ORK SATISFACTORY, PROCEED
~ ~ORREC A T~ND PROCEED
o CORRE 0', CALL FOR REINSPECTION BEFORE COVERING
Inspeclor: ( Owner/Contr:
~-t~5 OR THE NEXT INSPECTION'4 HOURS IN ADVANCE.
CODE \J UlREMENTS ARE FOR YOUR PERSO~AL HEALTH '" SAFETYI
INSHOTJ
_.--,---'..- .,.-....--.-....-... ---_.._,-_..__.~.---
Date Rec~d
CITY OF PRIOR LAKE PLUMBING PERMIT
Z-/9-a3
; ~,~ ~:~y \ PERMIT NO. /'I? _0//2 I \
). Yellow Applicant ~. Zi'lP,
(Please!VE~ or nrint and si.m at bottom)
ADDRESS . ZONING (office use)
/.:53(1;;7 giG /fO,e..V ~NS.J'
. LEGAL DESCRIPTION (office use only)
BLOCK
PID
LOT
ADDITION
OWNER
(Name)
(Phone)
\
(Address)
(Phone) q '52 -2 'U..v -,iI 3
ftl/OYL Lt11<.17 ~-s; 72,-
(City) (Zip Code)
APPLICANYl ~-
(Name) ;:: .1/..:2:,17
-I.
;V'llk'vd) /1\.1 (r
(Address) /7,)01
!-hM..-\ LO,--.J
(Address)
(Contact Person) J"'.,_~_T
TrL.<\1 L
I
I
~
I
I
~
I
I
(Phone)
APPLICANT SIGNATURE /]~-? //l.~'Z..~ DATE ~ -
'-/' / / - ,-
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
tlath Tub with or without shower
iJishwasher
t:ioor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
SinkS
. tlar 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
Quantity
Y--
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 # 0 3 ~ 018 (p.
..39'. 50
.50
4-0.0 0
$
$
$
Estimated Cost $
Building Official
Date
\ Paid 4-0. 0-0
\ Date
2-/9- ()3
Receipt N4- 3<?() 0
By --I
Of-. .
(Office Use Only)
J. This Application Becomes Your Building Permit When Approved
~ ?,/9-us
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714