HomeMy WebLinkAboutPlumbing Permit 11-0314 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED 2 (I
ADDRESS 1 h3 J C S L I r Cl
OWNER CONTR.
PHONE NO. PERMIT NO. / 1 - 3( y
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD /FILLING
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL ❑ GASLINE AIR TST
❑ SITE INSPECTION ❑ MECH FINAL )4 LJA-r. \ U rr
COMMENTS:
cue A_ _r/Lo
WORK SATISFACTORY, PROCEED
❑ CORRECT •TION AND PROCEED
❑ CORR- T •• K, CALL FOR REINSPECTION BEFORE COVERING
Inspect r: Owner /Contr:
CALL -9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOTI
P Rip Date Rec'd
�c CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Blue File
2. Gold city PERMIT NO. / / 3 / 4,._
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS t ; ci ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(N WN )R 6`, v'3t'p(1l f- ied.S (Phone) U U/p
Phone `
(Address) al 1 3 cj Or Se Pricy t a,e'e- MA/ 5c- 1
APPLICANT
(Name) (Phone)
A r'n are -
(Address)
(Address) (City) (Zip Code)
(Contact Person) < (Phone)
APPLICANT SIGNATURE •II , 1 f.' A&- l DATE t/4 / 1
/ ,I
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 1 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 $ Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $ 50
TOTAL PERMIT FEE $
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Cji Rece' t No. , Z �
Buildi Official Date Date ` , I 1 B
ng •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372