HomeMy WebLinkAboutPlumbing Permit #12-0578 .°�
°- DATE TIME
CITY OF PRIOR LAKE
lNSPECTION NOTICE SCHEDLlLED �b (e �
ADDRESS ��Q��� )P `pi['� J I�
OWNER CONTR.
PHONE NO. PERMIT NO. ( v ^ Z "�j�C/
0 FOOTING ❑ PI.UMBING RI ❑ EX/GRAD/FILLING
❑ FOUNDATION ❑ MECH RI t� COMPLAINT
❑ FRAMING ❑ WATER HOOKUP O FIREPLACE RI
0 INSULATION O SEWER HOOKUP ❑ FIREPLACE FINAt
❑ FINAL ❑ PLUMBING FINAL ��E�
❑ SITE INSPECTION O MECH FINAL
COMMENTS: �
� WORK SATISFACTORY, PROCEED
❑ CORREC7 CTION AND PROCEED
❑ CORRE T ORK, CALI FOR REINSPECTION BEFORE COVERlNG
Inspedor: Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH 6c SAFETY.�
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o � pRjo Date Rec'd
,, CITY OF PRIOR LAKE PLUMBING PERNIIT �, l(, r"�
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�. B,ur File pERMIT NO. , �.r (�
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3. Yellmv Applicam
Please or t and si at bottom
ADDRESS - ZONING �fl�ce ��
1�1S (,� �31 v�b�,rd Tr��:� I I� �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDI'TION �'ID
� ��' ln �UU l �� l . (Phone) �-C� �� `��
, (Address) L - 1, ��,p � � l ��L
APPLIC T � � � �1 (� f/.: (� f' y� f
(Name) G- � VY�� $ (Phone) -/ � `zJ `y �
(Address) W • �� " �`� �
(Address) (City} (Zzp Code}
(Contact Person) {Phone) �% �S� � �� �
APPLICANT SIGNATURE DATE
APPLICANT PLEASE COMPLETE BELOW
Quanti T e of Fixture uanti e of Fixture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato athroom Sink Stand Pi e ashin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall BackElow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One & T�vo-Family $149.54
Residentiat, Additions & Alterations $49.50
T'he Minnesota Statutes § 32bB.148 ��st $ Buildin� Permit #
"SURCHARGE" has been changed far one pLUMBING PERMIT FEE $ ��• � �
year effective
.lui,y �, 20i0 untii ,Dune 30 2011. STATE SURCHARGE $ .S`: w.�
The minimum stircharge for a fee" permii TOTAL PERMiT FEE $,_��. �0
is �, beginning July 1. 201Q
This Application Becomes Your Bnilding Perm►t When Approved Paid �7��� Receip � 7
-J � �
Building Offlciat Dste Date� r� /� By � ,
24 bour notice for a!1 inspections (952) 447-9850, fax (952) 447-0245
4646 Dakota Street S.E., Prior Lake, Mfnnesota 55372