HomeMy WebLinkAboutPlumbing Permit 15-0146 CITY OF PRIOR LAK DATE TIME
E
INSPECTIONI
NOTICE SCHEDULED ( Pi
ADDRESS 3 as3 J"42e
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/
9 /
OWNER
CONTR.
PHONE NO. PERMIT NO.
f
1-716
❑ FOOTING 0 PLUMBING RI
❑ FOUNDATION 0 MECH RI 0 EX/GRAD/FILLING
0COMP
❑ FRAMING LAINT
❑ INSULATION 0WATER HOOKUP ❑ FIREPLACE RI
❑ FINAL 0 SEWER HOOKUP 0 FIREPLACE FINAL
❑ SITEINSPECTION PLUMBING FINAL 0 GASLINE AIR TST
❑ MECH FINAL 0
COMMENTS: rT z 0 ,
WORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WO ,CALL FOR REINSPECTION BEFORE COVERING
Inspector Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
INSNOTI
Date 04 pRlp� ][.ec'd
,� ..,' CITY OF PRIOR LAKE PLUMBING PERMIT(3IJ )
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— r.:led c;t F;lr PERMIT NO J��.`,,,/
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e&3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(dike use)
,35 -3 rti,tiow wi Af by kw
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER ^^
(Name) ' t
,� 0 f9I\(\A 0 (Phone)
(Address) 5(6 ), 1 V�-e/If l- OAY \W
APPLICANT
(Name) L Lkt-I i) (Phone) qS3, " 'q(
(Address) 14-01 1\1 fltt-Old GuJ '? 4 ut. MA.bU J k. : .1iAOW S5\2.0
(Address) (city) (Zip Code)
-Pt(Contact Person) l ill (Phone) q S-)" "K 0 'II UUU
APPLICANT SIGNATU i lA1 71 P./f _ DATE c
V U U�
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher 1 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
I Bar SinkLawn Sprinkler
Water Closet(Toilet) Other
FEE SCHEDULE
The Minnesota Statutes§326B.148-- riot;cost with a$49.50 minimum Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended . ' Residential,Additions&Alterations $49.50
The minimum surcharge for a ' "
"fixed fee"permit is$5,00 $ /.--
°I' SD Building Permit#
PLUMBING PERMIT FEE $ 4-°i. 50
STATE SURCHARGE $ XXX 5.00
TOTAL PERMIT FEE $ i-1-.SO
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 3-440 Receipt No. !_77
Date2 . !8'65 I31 ,
Building Official Date
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.R.,Prior Lake,Minnesota 55372