HomeMy WebLinkAboutPlumbing Permit #13-1076 a� y Q E . TIME
CITY OF PRIOR LAKE
INSPECTION NOT(CE SCHEDULEO j� � �
ADDRESS �__1�,�/ �� �� 7''i�� ��d�'
OWNER CONTR.
PHONE NO. PERMIT NO. 1�j '"�/�/ ��
� FOOTING 0 PLUMBING R{ ❑ FJUGRAD/FILLING
i] FOUNDATION ❑ MECH RI ❑ COMPLAINT
❑ FRAMING ❑ WATER HOOKUP � FIREPLACE RI
❑ INSULATION 0 SEWER HOOKUP ❑ FIREPLACE FINAL
O FINAL O PLUMBING FINAL ❑ GASLINE AIR 7ST
❑ SITE INSPECTION O MECH FtNA� ❑
COMMENTS• J � /,� �,� �� �/��/' � �i
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Q�",�IORK SATISFACTORY, PROCEED
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❑ CORRECT ACTION AND PROCEED
❑ CORRECT WO , FOR SPECTION BEFORE COVERING
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Inspedor. OwnerlContr.
, -9850 FdR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH 6c SAFETY!
JNSNOTI
� .� Date Rec'd
CITY 4F PRIOR LAKE PLUMBING PERMIT
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3. Yellmv Applicanl
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ADDRESS ZONII�TG cot�ce „��
� � � � {j �. hh�� Ct�.-r✓� SV�/ . �t rior- � �,.
LEGAL DESC1tIPTION {office use only)
L�T BLOCK ADDITION PID
OWNER
{Name) U G � (Phone)
{Address) ( � ✓e, S !'/�' SS 3
APPLICANT
(Name) �7��?�- �ll`�.,_���I�Y��n� (Phone) `�5 2 _ G 7 S 3 - �-�' (�• � 3
{Address) �.���'' ���d�4�r►o� P� ��-V/dG�, �VJ �'��"O�
{Address} (City) � (Zip Code)
(Contact Person) �� � � � r� l � {phone} �5Z — `�S ,3 -- ���,J
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
Qaanti T e of Fixture uantit T e of Fi�cture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Flovr Drain Water Softener
� La.vato athroom Sink Stand Pi e ashin Machi.ne
Laun Tra 1 or 2 com artment sink Sewa e E'ector
- Shawer Stall Backflow Assembi
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler -
Water Cioset Toilet Otlier
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a$49.50 mix►imum Residential, New One & TtivaFamily $149.SQ
Residen#iaE, Additions & Alterations $49.50
The Minnesota Statutes § 32bB.148 ��st $ Buiiding Permi# # �
"SURCHA1tGE" has been changed for one �.�,R �
year ei�'ectiv� PLIJMBING PERMIT REE $ �
.Tuiy g, 2010, untit 3u�e 30, 201 d. STATE SURCHA.RGE $� D �
Thc minimum surclinrge fpr a "fixed fee" permit TOTAI.. PERMIT FEE $ 5 � �
is �5, begFnning 3uty 1, ZOXO --
This Application Becomes Your Bnitding �'ermit When Approved Pazd �� � Receipt Na D6 ��
Date � By
SuilclLus Off[ctal Date
24 hour noHce for all inspectious (952) 447-9850, f�x (952) 447-4245
4646 Dakota Street S.E., PrIor Lake, Minnesota 5S3'12