HomeMy WebLinkAboutPlumbing 03-1255
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
DATE TIllE
t()-l~ -r/3
ADDRESS
~ ":> L L.ro .5S-~d",.,
~r
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
CONTR.
PERMIT NO.
~ - / J;.s-~
o PLUMBING RI 0 EXIGRAD/FILLlNG
o MECH RI 0 COMPLAINT
o WATER HOOKUP 0 FIREPLACE R1
o SEWER HOOKUP 0 FIREPLACE FINAL
o PLUMBING FINAL 0 GASLlNE AIR TST
o MECH FINAL 0
!~4fJ/ $frtr-v
~
/
I
( /]Of/J
\ l) ->'--
"'----
~
~
r r \
r--l~ J
./
~
~ SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: j ./J /
V "..
CALL 447-9850 FOR THE NEXT IN~PECTION 24 HOURS IN ADVANCE.
Owner/Contr:
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IlISNOTl
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File PERMIT NO >1
2. Gold City' '0.:1- J "") \ C-S
3 Yellow Applicant ./ /(:;7'....J.
(Please type or print and sign at bottom)
ADDRESS 592b) C\'O~Vo.... ~te...+
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT tf BLOCK dADDITION
yY\ \ ~e '~ Ho\ l,-!
~
APPLICANT" 'is" t.. , ~ "
(Name) L)~ V\ ~'\J P ~
3 'ill ~tt tlJJ
OWNER
(Name)
(Phone) .9 6d-ddlr 3J4<g
(Address)
(Phone) .tJJ I J- R'O\ ' CG~D
kuJ(Ju~ 66360
(Address) (City)
(Contact Person) {)e..,lI\...v\.~'5 (Phone) f)a...m.1
}PLICANTSIGNATURE~ t ~A DATE 9.-ICo-C)~
APPLICANT PLE~ COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
I Shower Stall
Sinks
Bar Sink
I Water Closet (Toilet)
(Address)
~\4
(Zip Code)
Quantity
Type of Fixture
i
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
I Backflow Assembly
I Backflow Assembly Test
I Lawn Sprinkler
I 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 $
39 ~tf)
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
2lL 50
.50
LIO .OQ
JOffice Use Only)
Building Official
Date
Paid f.j{).---
Date?_/~_ 3
RecL1~~Ic~
B~
V
.I
'his Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
~\. \')
~\ '1)/ \.
\
,_. .~,
I
__"1_",.0"