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PLUMBING 16-0229
DATE //__ TIME CITY OF PRIOR LAKE r77 INSPECTION NOTICE SCHEDULED Z ADDRESS ./ -7 ci Cad o OWNER CONTR. PHONE NO. PERMIT NO. ( L - G ❑ 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 ❑ FINAL 0 PLUMBING FINAL GASLINE AIR TST ❑ SITE INSPECTION 0 MECH FINAL Q.r) - COMMENTS: W 4-g--- WORK SATISFACTORY,PROCEED O RECT ACTION AND PROCEED ❑ CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING Inspector: ner/Contr. CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE. CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY! INSNOTI O�pR/044 Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT f&. I cC)se 21 ol ri'` PERMIT.GGold CtyNO. [(4, O3 3.Yellow Applicant w (Please type or print and sign at bottom) ADDRESS ZONING(office use) -74L( w 5 . N E P(,k2 LEGAL DESCRIPTION(office use only) � LOT BLOCK ADDITION PID d'� ' i`'j `C� . p°7-0 OWNER (� (Name) \ `\G (Phone) (Address) APPLIC (Name) E'C-77QQ. (Phone) S, v c\ 4 (Address) C1 14 (D 1® LLE S75-0 q (Address) (City) (Zip Code) (Contact Person) © � (Phone) '�'<'�'`�E APPLICANT SIGNATURE _ �,, _� DATE Z-a b- 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 $ Building Permit# PLUMBING PERMIT FEE $ STATE SURCHARGE $ I.8V TOTAL PERMIT FEE $ .50, C-6 (Office Use Only) This Application Becomes Your Building Permit When Approved Paid 60.450 Receipt N (_ Date 3 . vv Y ,1 U`p L Y"By Cs�n ,, J Building Official Date 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372