HomeMy WebLinkAboutPlumbing 03-1170
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CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
DATE TIME
SCHEDULED c?-t:l-96
IS ~L/5"" fhI~ y;
CONTR.
PERMIT NO.
03- 1/7()
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
S tJr 1/ I V-
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
o
()IG
/) }/lc.e
~~-
'j "
L- /~
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o WORK SATISFACTORY. PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, c;!:,L F~NSPECTION BEFORE COVERING
Inspector: ~ ~ Owner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IN$NOT/
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
q. :3_ CJ 7
; ~~~ ~::, I PERtvll]' NO. a'? - ''/ '?II
3. Yellow Applicant J Ii /'"
(Please.!We or orint and sign at bottom)
ADDRESS
'5"21./:)
Jeff~-0
~/~
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2(.11/P .0"] o. ()
OWNER ,
(Name) :}eC<f\,',,\ e
(Address) J5} 'I)
/.J-O~h'1qn
]ef{;"r.s fi.,1J,
(Phone)
APPLICANT <:' --.1 /1 iJ)' I 1 J
(Name) -2> 7./ t"Ct '*' IT /'-'-.fn b, 1-,1 .-J f7'<j
tJ, / f. l:J -.J
(Address) /':)'i:;! /7tJ~ ::>-
(Address)
\O/"'Y\
(Contact Person) .J . A I
-~PPLlCANT SIGNATURE /,p.,
?
-.
.2{l::/
(Phone) 9g :2s'f Cia::(
J..c..ft""IJ/k /J'/n. S'5VIy'Y
(City) (Zip Code)
(Phone)
DATE
APPLICANT PLEASE COMPLETE BELOW
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 Pine (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink X Lawn Sprinkler
I Water Closet (Toilet) 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 $
:5'1. ~tJ
.50
4'11, , 0 .
(Office Use Only)
..1 This Application Becomes Your Building Permit When Approved
~Offic~9/~iJ
I Paid 10. ()()
I Date9/'0J
Rece2jt g.~ 7 j' I
By ~Mt-1 I
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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