HomeMy WebLinkAboutPlumbing Permit 11-803 '� T ME
CITY OF PRIOR LAKE 8 � —'T"t
INSPECTION NOTICE SCHEDULED
ADDRESS 199 ,;
OWNER CONTR.
PHONE NO. PERMIT NO. 1 j F 03 .
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD/FILLING ',
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL ❑ GASUNE AIR TST
❑ SITE INSPECTION ❑ MECH FINAL ' ( 1.6.,{. ti kr•.
COMMENTS:
4 WORK SATISFACTORY, PROCEED
CORREC TION AND PROCEED
❑ CORR CT , CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner /Contr:
CA 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
IMSNon
V RI 0 Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue
2 Gold City PERMIT NO. ifj g
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER C C\ •t•��
(Name) \\A
���� (Phone)GISo7 - 033) ` 5?j(L4.2
(Address) \� \ r C \OX MO c-s !-
APPLIC ► T
(Name) s - 1 • AIM ∎ _ ilt . £ (Phone) ( S ^ 9 0. 7 1
(Address) SOS 11� AI • �1i , ` �__ S' 1 0
(Address) (City) (Zip Code)
I
(Contact Person) LI 1.L (Phone) P -a - gD4
/) 1
APPLICANT SIGNATURE / / � __ DATE , l
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 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 $ 49. SO Building Permit #
The Minnesota Statutes § 326B.148 �0
"SURCHARGE" has been changed for one PLUMBING PERMIT FEE $ ' `-VA
year effective STATE SURCHARGE $ S -OD • f
July 1, 2010, until June 30, 2011. TOTAL PERMIT FEE $
The minimum surcharge for a "fixed fee" permit
is 15, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid Recei/. 6 , 3 45
Date Q / :4' ffYY
Building Official Date /1"1.4 1 e
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372