HomeMy WebLinkAboutPlumbing Permit #09-0166 � �� V
DATE TIME
CITY OF PRIOR LAKE �
INSPECTION NOTICE SCHEDULED '�� �
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ADDRESS _ Q '%d�� �� S�
OWNER CONTR.
PHONE NO. PERMIT NO. �9 � l(��
0 FOOTING ❑ PLUMBING Rt ❑ EX/GRAD/FILLING
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
� INSULATION ❑ SEWER HOOKUP ❑ FlREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL GASLINE AIR TST
❑ SITE INSPECTION O MECH FINAL �� ..
_ COMMENTS: �j,��
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❑ WORK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WORK, CALL FOR REINSPECTiON BEFORE COVERMG
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Inspector: j OwnedContr.
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS 1N ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH & SAFETY!
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0 � PRI ��P `J Date Rec'd
� D� CITY OF PRIOR LAKE PLUMBING PERMIT
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3. Yellow Appiicant •
lease or 'm and si at bottom
ADDRESS ZONING (oflFi�e use)
5�-o.� TrQ � l� eacat-- �--a �e S. E. ,�r � o r La k�
LEGAL DESCRIPTION (off'ice use only)
LOT BLOCK ADDITION PID
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(Name) � � f�ti CN J O S� (Phone) QSZ �I"�'7 S�J" 7�
(Address) J' 1� Ct� � �12CtC� ��IP. �J �. �1" i01� LOl�.2 55�J7�
(Name K'GL� � �� O � q (Phone) � J'` �O C ( �O q � �
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(Address) �C�J � � � Q � � � . � . L0.�E U 1 � � � 5J' �-`�
(Address) (City) (Zip Code)
(Contact Person) � � � I�r � ,y��r (Phone) � �✓� 1 -� - 6 Q � Q� �
APPLICANT SIGNATU DATE �`� 7• 0�
APPLIC PLEASE COMPLETE BELOW
uanti T e of Fixture uanti T e of Fixture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e Washin 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
FEESCHEDULE
Industrial, Commercial & Multi-family I%of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $ �-Q . S O
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ .�50 . D D
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid �� D � Receipt No. 5775�
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Date � y u By
Building Official Date � Z "
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372