HomeMy WebLinkAboutPlumbing Permit #14-105 pATE TIME
CITY OF PRIOR LAKE SCHEDIlLED d�/ °�� � ---
INSPECTION NOTICE
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ADDRESS � � � � � � � G � � �
OWNER CONTR. � 1
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PHONE NO. PERMIT NO.
p PLUMBING Rt ❑ EXIGRAD/FILLING
❑ FOOTtNG p MECH RI l7 COMPLAINT
p FOUt10AT10N p FIREPLACE Ri
p FRAMtNG ❑ WATER HOOKUP � F�REPLACE FINAL
p INSULATION O SEWER HOOKUP � GASLINE AIR TS7
INAL ❑ PLUMBING FINAL �
SITE INSPECTION D MECH FINAL
COMMENTS:
❑ WORK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WOR , ALL FOR REINSPECT{ON BEFORE COVERING
Inspector. � '� Owne�lContr.
CALI. 447-9850 FOR THE NEXT INSPEGTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARL� FOR YOUR PERSONAL HEALTH dc S�1FET�'�
LvsNOr,
O4 pRlp� Date Rec'd
� CITY OF PRIOR LAKE PLUMBING PERMIT � 2 �' r�
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2. Gold City / /
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1288C Ot � t 8IIa S St �fOLt01R
ADDRESS � � � � `�� ,� , J � � ZONIlVG �ot�re �>
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
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(Phone)
(Address)
APPLICANT 7 'T ? — / � t{
(Name) ��� � �`P S �°��`C' GZ.- �, rv�� 1� v /U !� � (phone) ��r �
�aaa�s� -�°'�'° t'��� 3� c� � t � , f `f, ��.,/� �., �l' �'
(Address) �,, (City) (Zip Code}
(Contact Person) �°� 0`� � �itJ l� �2 (Phone) � S�� ' � 7'� — l � �t �
APPLICANT SIGNATURE � DATE � � °�`� ^ � /
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APPLICANT PLEASE CUMPLETE BELOW
uanti T e of Fixture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain ✓ Water Softener
Lavato Bathroom Sink Stand Pi e Washin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Baz Sink Lawn S rinkler
Water Closet Toilet Other
FEE5CHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a$49.50 minimura Residentia(, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $ `�� S �
STATE SURCHARGE $ -
TOTAL PERMIT FEE $ ..�"'
(o�� u� oo�y)
This Application Becomes Your Building Permit When Approved Paid ��L 5 --� Re ei No. ��--1 Q,
7
Date.� .�� �� B
Building Official Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
.4646 Dakota Street S.E., Prtor Lake, Minnesot� 55372
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