HomeMy WebLinkAboutPlumbing 03-1185
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS -15..</.,1')
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE nME
SCHEDULED <7 -e . Q.1 ff-i
~J) D.r[.,_ ~_r-
CONTR.
PERMIT NO.
3 - /1l'J5"'
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
o EXIGRADlFILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR T!lT ^
~ "'......~ CS~"-
,
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREruRK. CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CAll! -'50 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE..
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOT,
-< "_._--~ --.. - --.-----..--..-.-...----- .-- -..--....., ---..--.".---....--
Date Rec'd
CfTY OF PRIOR LAKE PLUMBING PERMIT
I. B'", Fik I PERMIT NO. 3- l/g51
2. Gold City
3, Yellow Applicant
(Please ~e or print and sign at bottom)
ADDRESS
/S''/6-0
WCf()d ~
ZONING (office "<oj
~
LEGAL DESCRIPTION (office use only)
LOT I BLOCK 3 ADDITION tL/~ ,g~
PIDc25 - 38',2-0SS- D
OWNER
(Name)
(Phone)
(Address)
APPLICANT
(Name)
(Phone)
(Address)
(Address)
(City)
(Zip Code)
(Contact Person)
(Phone)
~PPLICANT SIGNATURE
DATE
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 Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3~S-D
.50
L-j 0 --
(Office Use Only)
I This Application Becomes Your Building Permit When Approved
Building Official
Date
I Paid /f{),,'
I Date q-Sl~
, ReceiPtl1531/'7
BY~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372.1714