HomeMy WebLinkAboutPlumbing 03-0793
CITY OF PRIOR LAKE
INSPECTION NOT/CE
ADDRESS
SCHEDULED
4 ('11-
=
r/1o'Jr~....
CONTR.
OWNER
PHONE NO.
peRMIT No.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITe INspeCT/ON
o PLUMBING RI
o MeCH RI
o WATeR HOOKUP
o SeweR HOOKUP
o PLUMBING FINAL
o MeCH FINAL
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COMMENTS:
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~. M,j (;l{~b~
-
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=:
=:
DA. TE TIllE
-~-/l
-
5- 7"1.3
o EJuGRADIFILLING
o COMPLAINT
o FIREPLAce RI
o FIRePLAce FINAL
o GASLINe AIR TST
0_
~~
4k.Jr~
o WORK SA TIS FACTORY, PROceeD
~ORRecT ACT/ON AND PROceeD
o CORReCT WORK. CALL FOR ReINSpeCT/ON BeFORe COVERING
'nspector: ~ ('-13 -~erlconlr:
CALL 447-9850 FOR THe NeXT INSpeCT/ON 24HOUR~ IliADVANCg,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL. IfEALTIf & SAFETY!
'NSNoTl
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PER.l\1IT
It ./f, oJ
\. Blue F;le I PERi~.IIT NO
'Gold Cl" lY . /'I? _ 0 '""70?1
J Yellow Applic:al\l ~ /7-...J
~'!ype or print and sign at bottom)
-ADDRESS
J./.18~ (!..#-o.L!J._nLLU_5~::Je-_I_;)
ZONING (offic,use)
LEGAL DESCRIPTION (offic, use only)
LOT
BLOCK
ADDITION
PID2S - 284-~ 03/- 0
OWNER' ~.../
(Name) k~ i J II) -JjlJd. 1/1 tf" L
(Address) '-I/8':J- ~~.
(Phone) qS~. 1o/-J+'1-
~~~.~,
'181("
APPLICANT. I . ~
(Name) ~TtlOl7) /luul" ).'-.AL(I. (Phone) bS"/- .J:L"l. J_'1,-'{()
(Address) I.~~ (idNAAJll<1d. >biI,Ij. qVllrLAJIf~-;; -55068
(Address) 1/ ' (City) (Zip Code)
(Contact Person) Jl, 1 ; J /) C. '--~~ ') (Phone)' 65"/. ./~'3 . .:t'J3LJ
APPLICANT SIGNATURE JI"'/"l..l ~. J-<.a.;O DATE ,0<.1' If." ~C0
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Draip
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Quantity
Type of Fixture
1
1
1
1
1
1
I
I
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
I Lawn Sprinkler
Other
I
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 # 03 - 0793
PLUMBING PERMIT FEE $
I STATE SURCHARGE $
TOTAL PERMIT FEE $
'-.69. SlJ
,50
-1-tJ.tJtJ.
(Office Use Only)
1 This Application Becomes Your Building Permit When Approved
Building Official
Dlte
I Paid40.00
I Date;..
(1/ .It 03
Receipt N44:h 53
BY;?
. /
24 hour notice (or all inspections (952) 447-9850, (ax (952) 447-4245
,