HomeMy WebLinkAboutPlumbing Permit 11-0164 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED �
ADDRESS 3�p6� ^ �.p� � ��.I�//
OWNER CONTR.
PHONE NO. PERMIT NO. �� —� �( 7
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOUNDATION ❑ MECH RI p COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
� INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL �ASLI E AIR TST
❑ SITE INSPECTION ❑ MECH FINAL
COMMENTS: �' ��`
�
a i
y� WORK SATISFACTORY, PROCEED
�O CORRECT ACTION AND PROCEED
❑ CORRECT , CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CA� -9 0 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
COD QUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY!
WSNOTI
��C pR_IO�, Date Rec'd
ti;'� �'i�� ����� CITY OF PRIOR LAKE PLUMBING PERMIT � � � � � � �
, �
c� ' �rn
„ ;
_ �
�r��!o�
1. Blue File PERMIT NO . I I
2 Gold City ' ^
3. Yellow Applicant � \(/
Please e or rint and ' at bottom
ADDRESS n ZONING (oEtice use)
` T ` �- '�k? .iL_ i �� p� t �� I CY � P'11 e, ��-'� 1--� <_��� "�j ��.
3�-c ��-� Y� � �- I �
LEGAL DESCRIPTION (oft'ice use only)
LOT BLOCK ADDITION PID
OWNER �
(Name) �,l��I�(�' �uTi�u (Phone) ����'�Zlv
(Address) �J(L G � .� � ;-> ���v�4� `�'f U �' �.f1'jC� �—1 fJ � �� ����.
—' �/ —�;�-(� ,�'�- �
(Nam�e� C� l� j� I^.'i i►�i `j�sA�v �� C� �^� ►�� (Phone) <=-�Z�—� �5 =��c
n �
(Address) �; �'> �; l �;' � A�� C-l1'?i'f.� /�''� � � ��Y �(-�l���� i �ti �� 7�'` ��
(Address) �— (City) (Zip Code)
(Contact Person) �� � � � (Phone) 1 �%� —�! � � ��' � �
APPLICANT SIGNATURE x� � � DATE �� �� �� � � �
APPLICANT PLEASE COMPLETE BELOW
Quanti T e of Fixture uanti T e of Fixture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain ( Water Softener
Lavatory (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 Closet (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
Estimated Cost $ Buiiding Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ �-1- `���
(Office Use Oniy)
This Application Becomes Your Building Permit When Approved Paid �/; _ r � R ce t No. ��' As,
�.,�, ..rCJ
Buildin¢ OtTicial Date Date �' (� y (( B �
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372