HomeMy WebLinkAboutPlumbing 03-1007
DATE TIME.. ~
'1- ll-o"LJtl
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CONTR.
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS ) 5d. ~2
OWNER
PHONE NO.
PERMIT 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
COMMENTS:
S - 100"7
o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLINE AIR,_ T:S _T. l ~
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t, \\ (Jj:r . LY
l iJI / >yP
~RK SATISFACTORY, PROCEED
o CORRECT A I01;ND PROCEED
o CORRECT R,' ALL FOR REINSPECTION BEFORE COVERING
Inspedor: Owner/Contr:
CALL ~ -98 .::6R THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE R~MENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
UiSNOTJ
~-_..,
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT,...... ), '\
\-W" ex \
l. Blue File I PERMIT NO l'
,. Go" Ci" .)\ 2. - /()O
), Yellow Applicant (../ -.,;;) ( ~
(Please tvoe or urint and sign at bottom)
I ADDRESS
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LEGAL DESCRIPTION (office use only)
LOT/~BLOCK ~ ADDITION I/9f'AUJ/n707/)(./).o
~
OWNER
(Name) ?UL.</.. ~,h ,,;-d..u
(Address)
/A>~e.s
. APPLICANT .
(Name) ?;'f!:L,5/,{)L ;OM' ~ H76
(Address) /..2C/" ,PI 2/",u,e/fP' At/L:
(Address)
~/I~I.-
d./~
..-
(Contact Person)
_. APPLICANT SIGNATURE
I Quantity
I
I
I
I
I
I
I
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)
ZONING (offi" ",e)
Js. -f-
pm;? 5" - 370 - Od4-0
(Phone)
(Phone) 9..~ -6'7Y-7GcJ 0
c...aY/l-6'.A:. 5r3,)'?
(City) (Zip Code)
(Phone) -S-~4'.€..
_ DATE.. 7/oZ.>/OJ
-- .~-
~.
Type of Fixture
.
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler - Pv't3 lS>N (C{
. Other
l
FEE SCHEDULE
Industrial, Commercial & Multi-family 1 % of job cost with a $39.50 minimum
Estimated Cost $
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Omce Use Only)
-1 This Application Becomes Your Building Permit When Approved
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
Residential, New One & Two-Family $99,Sk
Residential, Additions & Alterations ~
Building Pennit #
$ ,"Z 9. $'0
$ .50
$ ~_ Cob
Paid If/).-
Date?~30-...3
R, eceipt ,No. . .
. . /l--I L/ 1'S? ()
BY~
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