HomeMy WebLinkAboutPlumbing Permit #11-0539 �� �./
CITY OF PRIOR LAKE DATE TIME
tNSPECTION NOTICE SCHEDULED ��.Q�-/�
ADDRESS �� ! � �� �
OWNER CONTR.
PNONE NO. PERMIT NO. � 1-- �,��
� FOOTING O PLUMBING RI ❑ EXlGRAD/FILLING
❑ FOUNDATION ❑ MECH RI � COMPlA1NT
O FRAMING � WA7ER HOOKUP ❑ FIREPLACE R!
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
O FINAL O PLUMBING F1NAL O GAS INE AIR TST
❑ SITE INSPECTION O MECH FINAL �
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�WORK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: ` Owner/Contr.
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS !N ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY!
1NSNOTI
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04 rRlo� Date Rec'd
� � CITY OF PRIOR LAKE PLUMBING PERMIT �, 2� ��
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� '. B'°e F��e pERMIT NO. .�
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3. Yellow Applicant
lease e or ' t and si at bottom
ADDRESS ZONING (ofl�'ice use)
y to �1 b � r r��. L,/J
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) (Phone)
(Address)
APPLICANT n
(Name) � �' c -1 � �' (` L p � � �� � f � , � r� L (Phone) °� S� - �l y � - �l ( �
(Address) �o �C�O �. � � -. �' r �.. , P c' ; � r L y�--� (V�� �5.3 Z
( d ess) (City) (Zip Code)
(Contact Person) o..� �� d � c (Phone) �o I l - � - I 8� � y
APPLICANT SIGNATURE DATE L� " c�3' � �
APPLICANT PLEASE COMPLETE BELOW
Quanti T e of Fixture uanti 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 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
FEESCHEDULE
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
Rctimater� C:OSt $ Building Permit #
The Minnesota Statutes § 326B.148
" SURCHARGE ° has been changed for one PLUMBING PERMIT FEE $
year effective STATE SURCHARGE $ .50
duly 1, 2010, until dune 30, 201L TOTAL PERMIT FEE $
The minimum surcharge for a"fixed fee" permit
is �, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid� �-U Rece' t o.� 3�
Date � // By
Buildine Official Date � �
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372