HomeMy WebLinkAboutPlumbing Permit 11-0026 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED //2 &( r
ADDRESS /6 (1 ;r „_(.c
OWNER CONTR.
PHONE NO. PERMIT NO. ( 1 — Z (-t
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD /FILLING
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL ❑ GAS INE AIR TST
❑ SITE INSPECTION ❑ MECH FINAL r
COMMENT
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WORK SATISFACTORY, PROCEED
13 CORRECT • - • AND PROCEED
❑ CORREC • - , • LL FOR REINSPECTION BEFORE COVERING
Inspector: Owner /Contr:
CALL • - . ' 0 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
P R1 0 Date Rec'd
° �\ CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File
Z Gold City PERMIT NO . // /, o�
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3 Yellow Applicant ( kJ
(Please type or print and sign at bottom)
ADDRESS wortq � r � �� �� � r I ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER „ 11 ed , I � U I i� s q5q5 LI LI 6 � L
(Name) / �] 1n (Phone)
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(Address) 1 G � (/\ 1q 'i 1(k ct ''� �� - t 1
APPLICANT
(Name) r _ .. ” . i . u'r: o c` (Phone)
(Address)
(Addr i 0 PeC, i. t 3 J 5 +‘, (City) (Zip Code)
952 -445 -4803
(Contact Person) (Phone)
APPLICANT SIGNATURE Ellir �,1� DATE / t t t i 1 1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher j Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
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 $ .0 Building Permit #
PLUMBING PERMIT FEE $ ,4
STATE SURCHARGE $
TOTAL PERMIT FEE $ AT .. M
(Office Use Only)
I
This Application Becomes Your Building Permit When Approved Paid 9 4 , S --- 0 eipt No. 6 ap2
Building Official Date Date I ( I l / I y
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372