HomeMy WebLinkAboutPlumbing Permit 09-0406 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED (
ADDRESS J�'��O �LX��SW�O��
OWNER CONTR.
PHONE NO. PERMIT NO. q ���
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOUNDAT{ON O MECH RI ❑ COMPLAINT
❑ FRAMlNG ❑ WATER HOOKUP � F{REPLACE RI
Q INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL O PLUMBING FINAL ❑ GASLINE AI T
❑ SITE INSPECTION ❑ MECH FINAL � ��-
COMMENTS:
-�
�WORK SATISFACTORY, PROCEED
❑ CORREC TfON AND PROCEED
❑ CORR T W K, CALL FOR REINSPECTION BEFORE COVERING
Inspecto : OwnedContr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH dc SAFL�TY!
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O � pR Date Rec'd
� � CITY OF PRIOR LAKE PLUMBING PERMIT �, 2 2,d�
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�. B�ue F�le pERMIT NO.
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3. Yellow Apphcant � r
lease or ' t and si at bottom
ADDRESS ZONING (o�ce use)
LEGAL DESC1tIPTION (ofl['ice use only)
LOT BLOCK ADDITION PID
OWNER -- ( �
(Name) � (Phone) — 1
(Address) � �p ��� �
APPLIC I „
(Name) F one) � � � - UL /
(Address) v �
(Addr (City) (Zip Code)
(Conta.ct Person) L (Phone)
APPLICANT SIGNATURE G';1� �-- DATE �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e ashin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEESCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $ �-f ``� �� �
STATE SURCHARGE $ 5
TOTAL PERMIT FEE $
(Oftice Use Only)
This Application Becomes Your Building Permit When Approved Paid �, � Rece� •�'BZS�J
Date �� ZZ�G y
Bulldin¢ Offfcial Date •
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
, 4646 Dakota Street S.E., Prior Lake, Minnesota 55372