HomeMy WebLinkAboutPlumbing 03-1454
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
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OWNER
CONTR.
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:
if 1- ()
sE1-
DATE nME
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3 - /Lf~
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o EXIGRADIFILLlNG
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
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~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT W~RK. ~FOR REINSPECTION BEFORE COVERING
Inspector: r vr Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNon
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File I PERMIT NO
2. Gold City '0 '3 - Iii c-t'.. ,
3_ Yellow Applicant f....("'::> '1
(Please type or print and sign at bottom)
ADDRESS
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ptmt/t;td(Jt /J!1Jt \t;(
LEGAL DESCRIPTION (office use only) If) .
LOT / BLOCK / ADDITION fY. NA~j7a? If ~
&':~ ~ orilmJLniLLbinftJ
ts~ as ohOVi:')
ClJLLIQAi~ WAren CONDITIONING
6030 CULLIGAN WAY
1\l;tNNc;,ONKA. Mt..t G594:
(952) 933.7200
(Address) (City) (Zip Code)
(Contact Person) Ar~ \- S . (Phone) t?) 50 -qj d -7~7 0
)PLICANTSIGNATURE~~n(G jJ. DATE IOII~JDo
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (1 or 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
(Address)
APPLICANT
(Name)
(Address)
Quantity
ZONING (office use)
PID,dS- 39q~ {)o(-.D
(Phone) (!J~'itif~ ",57bLR
(Phone)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
lOffice Use Only)
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ ~~
Building Penn it #
,.
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$...3'1.5"0
$ .50
$ LtO.OO
Building Official
Date
--
Paid 1/ tJ ,~
Dat/6,~_3
Receipt N~ 0'8.;)-1
By Ci----.
:J '"
'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