HomeMy WebLinkAboutPlumbing Permit #14-216 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED ���,�� ' '
ADDRESS I �`� �Q��e� �
OWNER CONTR.
PHONE NO. PERMIT NO. d�" Z J�
0 FOOTING ❑ PLUMBING RI O EX/GRAD/FILLING
❑ FOUNOATION ❑ MECH RI ❑ COMPLAINT
O FRAMING ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
O FINAL O PLUMBING FINAL ��SL E A1 ST
❑ SITE INSPECTION O MECH FINAL ��
COMMENTS:
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�WORK SATISFACTORY, PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT K, CALL FOR REINSPECTION BEFORE COVERING
Inspedor. OwnedContr:
CALL 44T-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH dc SAFETY!
Lvsnon
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0 � r�o� _ - Date Rec'd
,� CITY OF PR.IOR LA�E PLUMBING PERMIT -.
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. �. s `�` e i'` pERMIT NO.
a oow n�
3, Ye11mv Applicant �
itase e or rint and s at battom
ADDRESS ZONING (otr�ce use)
I � � I � `�e�-FcrS �c�S S
LEGAL DESCRIPTION (oflflcc use onEy) ,
LOT HLOCK ADbITIQN pa} �
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(Name) Qv 1 C �— � Q (Phone} �Q 1 Z" �� � V [ �
(Address) � �� I � �J � ���.,5 � S S � ^ � �rl. �
APPLXCANT � ) t � � -1 �Q� � 1 V C� C �
(Name) � � hone 4
(Addxess) �� 1 � (�(�� SV l, � S S 3 J
� �d� S� � (City) � � (Zip Code)
(Contact Person) � ' � �Phone) � " I V
APPLICANT SIGNATURB DATE
APPLICANT PLEASE COMPLET� BELOW
uanti T e of Fixte�re Quantl T e of Fixture
Bath Tub with or ivithout sl�ower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e Washin Machene
Laund Tra 1 or 2 eom artment sink Setir►a e E"ector
Shower Stall Backflaw Assernbl
Sinks Backflow Assembi Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
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Tlte itqinnesota Stat��tes § 3268 ,1'Q.g ,_ joli cost with �44.SO, ResIdential, New One & Two-Fami(y 50 �
" SURCHARGE " has been extended � Residential, Additions & Altc�ation $.50 '
� The �ni��intuin sui•charge £oi• a � .
"�ixed fee" permft }s �S.QO ' � Building Permit #
� PLUMBING PERMIT FEE $ �___�__-- S �
STATESURCHARGE $ 5.00
TOTAL PERMIT �EE $ ��-� . S �
{Oflice Use Only) • -
This Applicatiou Becomes Your Butlding Permlt When Approved Paid 5 -� Rcce' No. !J / r �
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Date / S ! _ . ;
HuUdin¢ Ofttciai Date � �
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24 l�our notice for aU inspectfons (952) 447-9850, fax (952) A47-4245 �
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st645 Dakota Street 5.�,, Prior Lake, Minncsota 55372 i
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