HomeMy WebLinkAboutPlumbing Permit 12-0093 DAT TIME
CITY OF PRIOR LAKE o2 fS
INSPECTION NOTICE SCHEDULED /2_
ADDRESS �C—
OWNER CONTR.
PHONE NO. PERMIT NO. ) 722 (� b
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD /FILLING
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL I GASL!NE A T T
❑ SITE INSPECTION ❑ MECH FINAL l �k er �JeA (f
COMMENTS:
I nc
('WORK SATISFACTORY, PROCEED
❑ CORRECT TION AND PROCEED
❑ CORRE W K, CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner /Contr:
CALL 447- 850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODER QUJREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNOT)
Rip •Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT a, 6 �2
c ivisiEse
1. B F i l e PERMIT NO. /2 t� z
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3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
230 5 5
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
((Na WNER n�� , CWt L5O'n (Phone) 9 I J3
(Address) ( of LK 53
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APPLIC Q Rurr (� h ( Phone) �J
(Address) d S flO plJd. 4 Q " N 55/ 23
ddress) ( ty) (Zip Code)
S (Contact Person) (Phone) ���I✓v r �
APPLICANT SIGNATURE DATE V 1—' 2—
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher k 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
The Minnesota Statutes § 326B.148 st $ Building Permit #
"SURCHARGE" has been extended �(�-�
until June 30, 2013, PLUMBING PERMIT FEE $ 33
The minimum surcharge for a STATE SURCHARGE $ .50
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid Czi 5 -6 Rec ' t No.& YS "
Date .Z ? Z
!
Building Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 LAP Dakota Street S.E., Prior Lake, Minnesota 55372