HomeMy WebLinkAboutPlumbing Permit 11-0766 / TE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED Air. _ '
ADDRESS /5.—
411; / l► :,,, ter
OWNER CONTR.
PHONE NO. PERMIT NO. //,
7
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRADIFILUNG
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
FINAL PLUMBING FINAL ❑ GASLINE AIR TST
/ ❑ SITE INSPECTION ❑ MECH FINAL ❑
COMMENTS: a.h
'1 l' ua
V WORK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT Wile � Cal L FOReREINSPECTION BEFORE COVERING
Inspector: A , ! , Owner /Contra
CALL 447 -9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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1 - 0 , Rio Date Rec'd
I .h Y CITY OF PRIOR LAKE PLUMBING PERMIT
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sijNNESdcA 1. Blue File
2. Gold city PERMIT NO. ii 7&&
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
/sails wilds kvreway
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
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( O Na WNER C n 5 KJ (Phone) 9S1 1 " " 1
(Address) ∎C € PrW L--La-- L/ 5 53 ��
APPLICANT Champion Plumbing
# 61770 -PM
(Name) 651 365 1340 (Phone )
70 (Address) Eagan, Dodd
N 55123
(Address) - (City) (Zip Code)
(Contact Person) (Phone) Q
APPLICANT SIGNATURE DATE `1 � — i 1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Ro . . 1 -'ns
Dishwasher Water Heate
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
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---' " - 1 $ Building Permit #
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extende PLUMBING PERMIT FEE $ 1J
until June 30, 2013, STATE SURCHARGE $ S 030
The minimum surcharge for a
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ x.
This Application Becomes Your Building Permit When Approved Paid 5) o Rece No. / � (Y
V (/ G
Buildine Official Date Date // - `/ B `
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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