HomeMy WebLinkAboutPlumbing 03-1400
DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED JtJ.~-~ I: ~ 0
ADDRESS J5?.~ \ J~~~c;. Pc...-S.S
OWNER CONTR.
PHONE NO. PERMIT NO. ~- I f.{oi)
o FOOTING o PLUMBING RI o EXIGRADIFILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL o GASLINE AI~ST
o SITE INSPECTION o MECH FINAL )( J.V~ ~d ~
COMMENTS:
~RK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORREn-~fK. CALL FOR REINSPECTION BEFORE COVERING
Inspector: f ~ Owner/Contr:
CAL _ 44~85.(OR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE ~REMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY!
LNSNOTl
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. 81ue File I PERMIT NO ,..-,
i ~~:~w ~~~Iicant . !J 3- / L( () U
(Please type or print and sie;n at bULLun,)
ADDRESS
-1520/ ,~).,;P~F~rS &:tc::;S
ZONING (office use)
12
l
LEGAL DESCRIPTION (office use only)
LOT.5 BLOCK ! ADDmON((/t'i/ (72u41-
OWNER . ~ L/
(Name)~YJYI J ,VOV-O-.r>
(Address) (: CalYY~- ~ Q;. JLboVe- ')
PID:;2S- 3?0.... (JO 5-0
(Phone) q Cd- dr:3it> - S;;::;-/~ 1
'PLICANT SIGNATURE
CL}!.-LlGAN WATER CONOITIONd~G
~O~() CULLIGAN WAY
M'NNETONKA, MN 55345
!9:2) 933-720(\
(Addrds) (City) (Zip Code)
'., l \teuPf1~ (Phone) Cf C);:)- .,. q I d - 7 h 7 {)
~.f()teIJfJ1( DA~E jll~? -
(Phone)
APPLICANT
(Name)
(Address)
(Contact Person)
Quantity
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)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
I Backflow Assembly Test
Lawn Sprinkler
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 $ ......-:7{ A ./
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ \.. ::F1 ~~ 0
$ _ .50
$ 4/)10 (J{2
(Office Use Only)
~
-~.
Building Official
Date
Paid 1)1/--
Dio-/1-&3
Rei7n0<1
By 9--.,
'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
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