HomeMy WebLinkAboutPlumbing Permit #10-0500 � �� DATE TIME
CITY OF PRiOR LAKE
INSPECTION NOTICE SCHEDULED ��r ,3
ADDRESS l l ! �� �� ' C� � �
OWNER CONTR.
PHONE NO. PERMIT NU. 1� '"� ��C.�-�
D FOOTING 0 PLUMBING R1 O EX/GRAD/FILLING
❑ FOUNDATION ❑ MECH RI O COMPLAINT
O FRAM(NG ❑ WATER HOOKUP 0 FIREPLACE RI
❑ 1NSULATION ❑ SEWER HOOKUP ❑ FIREPtACE FINAL
❑ FINAL ❑ PLUMBING FINAL t� G INE AIR TST
❑ SiTE INSPECTION � MECH FINAI. '�]
COMMENTS: � =��
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C� WORK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
O CORRECT WORK, CALL FOR REINSPECTION BEFORE COVERiNG
Inspector: OwnerlContr.
CALL 447-9850 FOR TNE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNOTI
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o .� rRip� Date Rec'd
CITY QF PRIOR LAI�E PLUMBING PERMTT
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2. c��e c,� PERMIT NO. /D . �a
3. Yd1ow Applicant
lease or nt and sI n at battom
ADDRES5 ZONING (otnce use)
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LEGAL DESCRIPTION (o&ice use onty) '
LOT BLt�CK ADDTTI�N PID
(I�I� Jr 1 {�l Y � Y��—uGl (Jl.r (Phone) �Q I.o� �J OtS� �
(Address) �� � ��.-+
APPLTCAAiT � � i �
(Name)� � . � �'� � �,� :�'� : Y. i �' `�L�. '� (Phone} �' � ��. �� � ''�� # �
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(Address) _ '� � � h - � `� � � �.
(Address) (City) (2ip Code)
(Contact Person) ' � (Phone} {.k' � � � C� � '� � �..J �
AI'PLICANT SIGNATCntB DATE � �� �
APPLICANT PLLASE CfJMPLETE BELOW
uanti T e of Flzture uanti T e of Tixfure
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
- Floor Drain Water Softener
Lavato at(uaom Sink Stand Pi e ashin Machine
�" Laund Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stalt Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink La�vn S rit�kler
Water Claset oitet Other
FEE SCH�DULE
Industrial, Commercial & Multi-family 1°.� of job cost with a 5�44.50 minimam Residentiat, New One 8c Ttvo-Family � 149.50
ftesidentisl, Addltions & Alterations 549.50
Estimated Cost $ Bailding Permit #
PLUMBING PERMIT FEE $ �, �'�. � �
STATE SURCHARGiE $ �� 0
TOTAL PERMIT FEE $—�(� � 6�
(OfIIc� Use Only)
Thfs Appifcxtion Becomes Your BuiIding Permit When Appreveti Paid J � �� Recei o. ���C�
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Data �� /l, /0 B
BnlWine Ofticiai Aate '
241four nottce for sil inspections (95�j 447-9854, faz (952) 447-9245 . �
4646 Aakota Street 5.�., Prior La&e, Minneaota 55372
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