HomeMy WebLinkAboutPlumbing Permit #12-0227 � �
DATE TINIE
CITY OF PRIOR LAKB
INSPECTION NOTICE SCHEDULEO S :��! "� : �
ADDRESS ��� /�j S
OWNER CONTR.
PHONE NO. PERMIT NO. � � � ��� �
O FOOTING � PLUMBING RI ❑ E7UGRAD/FILLING
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMtNG ❑ WA7ER HOOKUP ❑ FIREPIACE RI
❑ tNSULATION ❑ SEYVER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL O PLUMBING FINAL O GAS E AIR TST
❑ SITE INSPECTION O MECH FINAI �Q
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COMMENTS: .�2�.
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0; WaRK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
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Inspector: w � OwnerlContr:
CALL 447-3850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY!
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o � rRj •�� Date Rec'd
� � CITY OF PRIOR LAKE PLUMBING PERMIT
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� i: coia c�� �ERMIT NO.�� •2�"
3. Yellow Applican[ �
lease e or rint and si at bottom
ADDRESS ZONING (ofie�e Use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER '
(Name) (Phone)
(Address)
APPLICANT � � q��2'� 1.� / � � V `/ �
(Name) Phone
(Address) - W� � V]� �
(Ad r ss) (City) (Zip Code)
(Contact Person) (Phone) �Z� li� ! l! l' 1����
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APPLICANT SIGNATURE DATE !�
APPLICANT PLEASE PLETE BELOW
Quanti T e of Fixture Quanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e ashin Machine
Laund 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, 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 �`=ost $ Building Permit #
"SURCHARGE" has been extended Q �
until june 30, 2013, PLUMBING PERMIT FEE $ �' -{�
The minimum surcharge for a STATE SURCHARGE $
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid � �` eipt No. S 3
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Date � � � � d i -L y
Buildin¢ Official Date �
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372