HomeMy WebLinkAboutPlumbing Permit 11-0126 ATE TIME
CITY OF PRIOR LAKE �
INSPECTION NOTICE SCHEDULEO � ll �
ADDRESS , t[/ '"� t_? i t"4 �,.�'�z O�'l-`'�"Q'
OWNER CONTR.
PHONE NO. PERMIT NO. ��!( Z �
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOUNDATION � M�CH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP � FIREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL ❑ GASLINE AIR TST
� SITE INSPECTION ❑ MECH FINAL ❑
COMMENTS: ��/¢- yZ-�- /1�'�
_ �
�
._---�
G � �S� !%/�
(�WORK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT W L FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CALL 447-9850 FOR T T INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
lNSNOT!
� � p Rlp Date Rec'd
� '" �� CITY OF PRIOR LAKE PLUMBING PERMIT Z Zp} ��
� ��
v
�
n
�NNES�'� ; B F pERMIT NO. �I �Z �
_. c�,ia ca}
3. Ycllo«� Applicant
(Please e or rint and si n at bottom)
ADDRESS ZONING (o�tice use)
,
��
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER (,, �.,,��{ (�L
(Name) ��141� 1 11 IU����1 n ( ) / .J� `fc� � 7
Phone
�. c�?�1�
(Address) � . �
APPLICAN ` �,' �� � �
(Name) � u.�"1 (Phone) �
(Address) � � � � � ��
, (Addr•ess) (City) (Zip Code)
(Contact Person) � - (Phone) �, � - �� ( ��( �
APPLICANT SIGNATURE � � �� � DATE � — ��� �
APPLICANT PLEASE COMPLETE BELOW
Quantit T e of Fixture Quantit T e of Fixture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato (Bathroom Sink) Stand Pi e(Washin Machine
Laund 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 Goset (Toilet) Other
FEE SCHEDULE
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
- �st $ Building Permit #
The Minnesota Stat�ites $ 326B.148 , -
"SURC[ Ii1RGl�" h1s bccn changcd ti�r onc PLUMBING PERMIT FEE $ °�
vcar e17'cctivc STATE SURCHARGE $ �i .�
Juh� f. 2010, unYil Junc 30, 2(�l [.
"I'hc minimum simch;�r�c for a"Gxed f'cc" permit TOTAL PERMIT FEE � �, �,�r ]
is ti;, bc�;inning Juh 1, 2010
This Application Becomes Your Building Permit When Approved Paid �� �� Re i t No. /_ Z Q��J _
� �U �.
Date � 8 ` t / B ,
Buildine Official Date {
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 ��� �=K/
�