HomeMy WebLinkAboutPlumbing Permit #13-0345 �/ pAtE TIMH
CITY OF PRIOR LAKE � I•/� _.----
INSPECTION NOTICE SCHEDULED �
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ADDRESS
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CONTR.
OWNER � .� '7 —
PERMIT NO. _�--�
PHONE NO•
p PLUMBING RI ❑ EXIGRI►��FiLLIN
p FOO7iNG p MECH RI C] COMP�A�NT
❑ FOUNDATION p FIREPLACE RI
O FRAMtNG ❑ WATER HOOKUP � F�REPLACE FINAL
❑ INSULATION O SEWER NOOKUP � GASLINE � TST
p FINAL O PLUMB�NG F1NAL a �. � J ,
❑ SITE tNSPECTiON
p MECH FINA�
COMMENTS:
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�J� WORK SATISFACTORY, PROCEED
p CORRECT AC7lON AND PROCEED
❑ CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERiNG
; " Owner/Con1r.
inspecior:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS �� &�FETY!
CODE REQUIREMENTSARE FOR YOUR PERSONAL NEAL
lNSNOT7
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�4 YRtp� Date Rec'd
� CITY OF PRIOR LAKE PLUMBING PERMIT �/ �
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'. B`"` F" y PERMIT NO. 13 r , Q��
2. Gold Cit
3. Yellow Applicant
lease or ' t and ' at bottom
ADDRESS ZONING co�ce,�>
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LEGAL DESCR�TION (office use only)
LOT ��BLOCK r ADDITION �,� j� pID -
o�R � ,��? �y�? - � �
(Name) hone
(Address)
APPLICANT A�
(Name) 12850 �Chestnut Blvd. �phone)
(Address) J52 -445-4803
(Address) (City) (Zip Code)
(Conta.ct Person) (Phone)
APPLICANT SIGNATURE DATE �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fiature uanti T e of Figture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e Washin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEE SCHEDULE
Industrial, Commerciat & Multi-family 1% of job cost with a$49.50 minimum Residential, New One &c Two-Facnily $149.50
Residential, Additions & Alterations $49.50
The Minnesota Statutes § 326B.148 «$ Building Perm't #
" SURCHARGE " has been extended pLIJMBING PERMIT FEE $
unril june 3�, 2013, STATE SURCHARGE $ f .50
The minimum surchai°ge for a TOTAL PERMIT FEE $
"fixed fee" permit is $5.OQ � ( (/, 1 �r�
' 2S `'� I
This Application Be omes Your Building Per 't Whe Approved Pa� n1 �S� Receipt No. ��/ 7
� l�� C� 7 I �d
Date .� ,y, By
Bnildine Official Date /
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dskota Street S.E., Prior Lake, Minnesota 55372
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