HomeMy WebLinkAboutPlumbing Permit 09-0148
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
(pS~
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE
SCHEDULED ~
~~
TIME
CONTR.
PERMIT NO.
f -/c./$
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
! G~A~~~T "
,(\ /),
('\ o:;p r-WA l~ \ I?
- .
~WORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREctWdRlOcALL FOR REINSPECTION BEFORE COVERING
Inspectorl -.LLLI , Owner/Contr:
CALC'1f47-98sJOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE RE~MENTS ARE FOR YOUR PERSONAL HEALTH .{ SAFETY!
INSNOTI
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
(Please type or print and si~n at bottom)
ADDRESS
~5Cl5' ffttr h(Jr i~QL" NE.
I. Blue File I PERMIT 0
2. Gold City N .O~, (> / A~
3. Yellow Applicant 7 , ~ U
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER, I' i j I
(Name)"--~S -,vltlrv 00
I /
(Address) \. \(LrY\ () !
firc~ J~
H-JIJf1 U~:
(Phone) 9 5' 2-~o3 - f:::i>'-/~
C-~'?_
fJ1 (\/. ~)50 77--
APPLICANT
(Name)
(Address)
Champion
651-365-1340
36f~~~d.#100
Eagan, MN 55123-1339
(Phone)
Quantity
~IS/);~~1
~-
/._,~
... --- ~
1/
APPLICANT PLEASE COMPLETE BELOW
I Type of Fixture I Quantity I
I Bath Tub with or without shower I I Rough-ins
I Dishwasher I I Water Heater
I Floor Drain I Water Softener
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundry Tray (1 or 2 compartment sink I Sewage Ejector
I Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink I Lawn Sprinkler
I Water Closet (Toilet) I Other
(City)
(Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
DATE
Type of Fixture
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $ tfq,SD
STATE SURCHARGE $ . .50
TOTAL PERMIT FEE $ c: '') '))
'"l# .1.\#
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Buildinl! Official
Date
Paid 00.0 t)
Date 1-, l/q, oj
Receipt No.
BY/.
5772.. /
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
.37l.o<O J--
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