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A , 0 CITY OF PRIOR LAKE PLUMBBIN PERMIT
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'. Gold File PERMIT NO 2
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3. Yellow Applicant VVVV
(Please type or print and sign at bottom)
ADDRESS l ml
-- 001\010---G Thl, ZONING Office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
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OWNER (Name U e I (Phone) U . 0 '-L (21
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APPLICANT e %' P1 i , I � 1 . � _ MI Phone) C I , L W , grn
(Address) ' �1 � I A ♦ .� _ .
( . rs) (City) (Zip Code)
(Contact Person) it U' Ik I (Phone)
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APPLICANT SIGNATURE 41 11. / DATE ID V et
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V PPLICANT PLEAS COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 1 Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
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
Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $ L ICT C l e'
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $Y
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
5 UV Rec pt o� G � i
Date By . � 1 � 7
Buildine Official Date /0. 2.1-0 '
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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Monday, April 8, 2013
Current Resident
15287 FAIRBANKS TRL
Prior Lake, Minnesota 55372
Re: Building Permit Number 08 -0883. We request your help
In review of the building permit files, it was discovered there is an open permit for
Water heater at the above address. Please call by Monday, April 22, 2013 to set
up an inspection. If there has been no contact from you by this date, the City will
deem the permit abandoned and invalid. (per State Building Code R105.3.2). This
permit abandonment will be recorded in the permanent public record for this
address.
Any new work relative to this type building permit will require a new permit along
with new permit fees.
Please call the Building Department at 952 - 447 -9850 to schedule your inspection
date.
Thank you for your cooperation,
Sincerely,
Building and Inspections Department
City of Prior Lake