HomeMy WebLinkAboutPlumbing Permit 13. 0846 TE TIME
CITY OF PRIOR LAKE y /
INSPECTION NOTICE SCHEDULED ?�
ADDRESS / 7C7
OWNER CONTR.
PHONE NO. PERM NO. /
❑ FOOTING ❑ PLUMBING RI • a "
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE Ri
❑ INSULA ION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
+FINA ei /C ❑ PLUMBING FINAL ❑ GASLINE AIR TST
❑ SITE INSPECTION MECH FINAL ❑
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❑ WORK SATISFACTORY, PROCEED
%CORRECT ACTION AND PROCEED
❑ CORRECT WOR , C • L FO ` REINSPECTION BEFORE COVERING
Inspector: Owner /Contr:
L 9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
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CITY OF PRIOR LAKE PLUMBING PERMIT 7 _6,..t3
I. Blue File PERMIT NO .
2. Geld City �/�
3. Yellow Applicant �� ��LL//
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
1 15:3 K-0 e,et4k
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER "") /
(Name) / / (Phone)
(Address)
APPLICANT� (Phone) f Z It 7
(Name) w - ce (P ) a
(Address) V2 d fiagr da /he
(Address) (City) (Zip Code)
(Contact Person) )1 ) Cl G/�6`tit , (Phone)
APPLICANT SIGNATURE i/' C �� `''`�' fszl�"'� ""`.-_ DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 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
The Minnesota Statutes § 326B.148
"SURCHARGE" has been extended $ Building Permit #
The minimum surcharge for a
"fixed fee" permit is $5.00 PLUMBING PERMIT FEE $
STATE SURCHARGE $ .50
TOTAL PERMIT FEE ,
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid --I( S n Rec i No. 6 5 -2,/
Date By
Building Official Date / 4 ( .
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372