HomeMy WebLinkAboutPlumbing Permit 14-1371 DATETIME
CITY OF PRIOR LAKE —/
INSPECTION NOTICE SCHEDULED / G[�I
1
ADDRESS ?' l9r;� 1.... .
P,
OWNER CONTR.
PHONE NO. PERMIT NO.
❑ FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING
❑ FOUNDATION 0 MECH RI 0 COMPLAINT
❑ FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
❑ INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
INAL 0 PLUMBING FINAL 0 GASUNE AIR TST
❑ SITE INSPECTION 0 MECH FINAL 0
COMMENTS: In)c t /-4 ---
LL
1
^
r
.WORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED f
❑ CORR ?
RK,CALL FOR REINSPECTION BEFORE COVERING
Inspector. ii
Owner/Contr.
1111,
CALL —•850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
wsxorI
4 PRN• Date Rt c'd
CITY OF PRIOR LAKE PLUMBING PERMIT -
1
�rSoSt. D[ue'
z.Gold citFile
y PERMIT NO.N-1,371
I
(Pleasetype or print and alga 3.Yellow Applicant
p gnat bottom)
ADDRESS ZONING(once use)
1 cyr ),!v,obctice eel so 2
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID ZG-�
OWame)NER J ) e�
(N (Phone) (D)Z-S02-—2964
(Address) e 1) Se r l tic )fl k ? S&)
APPLICANT A A q
(Name) k &Nhone)'" ► EC H A J) I cF 1 CoCt(� �Z SO%
(Address) (.P zn 6. 5 A.)4) Ne,',GJ i9rA U 5O7) _
(Address) (City) 0 (Zip Code)
(Contact Person) ! ) A V ) (Phone) 7 2- / ),
APPLICANT SIGNATURE . " r r ,,tit DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher , 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
Bar Sink Lawn Sprinkler
Water Closet(Toilet) Other
FEE SCHEDULE
The Minnesota Statutes§326B,148 Nob'cost with a$49.50 minimum Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended Residential,Additions&Alterations $49.50
The mininnum surcharge for a
"fixed fee"permit is$5.00 $ Building Permit#
.PLUMBING PERMIT FEE $ et ,15-C.)
STATE SURCHARGE XVI 5.00
TOTAL PERMIT FEE $ 5 * �()
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid pitvz gig) Receipt No3 J
Date 42--' 7_/1 By n„,
Bulldine Official Dater I(.L��
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372