HomeMy WebLinkAboutPlumbing 03-1096
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CITY OF PRIOR LAKE
INSPECTION NOTICE
DATE TIME
SCHEDULED
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ADDRESS
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OWNER
CONTR.
PERMIT NO.
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PHONE 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
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o EXIGRADfFlLLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
COMMENTS:
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~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK ALL FOR REINSPECTION BEFORE COVERING
6- ). \ ~o? Owner/Contr:
Inspector:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH.l SAFETY!
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Date Rec'd
CITY OF' PRIOR LAKE PLUMBING PERMIT
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I. Blue File I PERMIT NO
2 Gold Ci,y 'Oy-to f'-
J. Yellow Applicant
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ZONING (office use)
ADDRESS
55#
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LEGAL DESCRIPTION (office use only)
LOTS BLOCK I ADDITION ~/jl./ln- R:106t6 21o./~
PID 2.5.302. /J05. ()
I OWNER
(Name)
(Address)
(Phone)
APPLICANL- . t\ 1. "
(Name) J eY'hf Ir ~M,o '^f ~.
(Address) / ,1<1 t ~r(Jr--/ /5 (yd.-.
(Address)
(Contact Person)
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(Phone) 7C.7 - 7.rJ- 'Y'dJ.r
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(City) (Zip Code)
(Phone) J~' /'
?PLICANT SIGNATURE
DATE
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough.ins
Dishwasher Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks . ~ Backflow Assembly Test
Bar Sink (..J Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
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 # OJ. / () q &
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
J'1- !::J-V
50
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(Office Use Only)
'his Application Becomes Your Building Permit When Approved
Building Official
Date
Paid -fOJJ ()
Date~. -Z.(UJJ
24 hour notice for all inspections (952) 447-9850, fax (9S2) 447.4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN S5372-t714