HomeMy WebLinkAboutPlumbing Permit 16-0067 DATE TIME
CITY OF PRIOR LAKE SCHEDULED I -----
INSPECTION NOTICE
ADDRESS 1 5-13 I 4t/a, 4 ,a.
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OWNER
CONTR.
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PHONE NO. PERMIT NO. I c--
0 PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOOTING 0 MECH RI 0 COMPLAINT
❑ FRAMING ❑ WATER HOOKUP
❑ FOUNDATION0 FIREPLACE RI
❑ FIREPLACE FINAL
❑ INSULATION 0 SEWER HOOKUP 0 PLA AIR TAT
❑ FINAL LUMBING FINAL
❑ SITE INSPECTION
0 ECH FINAL 1-5—E-45---;,9
COMMENTS: 67 i .4-,
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rWORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WORK CALL FOR REINSPECTION BEFORE COVERING
Owner/Contra
Inspector:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
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(� CITY OF PRIOR LAKE PLUMBING PERMIT ,( �
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.GoCitr PERMIT NO J
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Applicant •
(Pleasetypeor print and sign at bottom)
ADDRESS ZONING (officeua)
/ 573 / W vc- . Sf_
LEGAL DESCRIPTION (office usa only)
LOT BLOCK ADDITION PID
OWNER
(Name) ! OTY) F/I/ (Phone)
(Address) J / 3 ) 1 i .
APPLICANTS ! ]_ ,/1/
(Name) /Wk-t.77 y1 F e-1 7" /'Ld J1 )✓)r�)j .�Y)( ., (Phone)
(Address) 1 91('ii) fc` JCC ;)l A/oJ.. (- / ,. )Vf,� ��33 Q
(Address) (City) (Zip Code)
(Contact Person) I )?) ) C, ' (Phone) 75 ' - c-
APPLICANT SIGNATURE UI,1'v1 ✓ 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
Industrial,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
Estimated Cost $19OO Li) Building Permit#
PLUMBING PERMIT FEE $
STATE SURCHARGE $ $1.00
TOTAL PERMIT FEE $ J_7r.)
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid n Receip o.
Datel Z�+ L/ BY
Buildme Official Date 1 tp
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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