HomeMy WebLinkAboutPlumbing Permit 16-1214 TY LADATE TIME
INSPECTION PRIOR NOTICE SCHEDULED 0(
pc
ADDRESS
OWNER CONTR.
PHONE NO. PERMIT NO. ( . I z
❑ 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 _❑ OASLINE AIR TST
❑ SITE INSPECTION 0 MECH FINAL
COMMENTS: 1-1_Z0
WORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENT S ARE FOR YOUR PERSONAL HEALTH&SAFETY!
INSNOTI
PR/0 Date Rec'd
it0CITY OF PRIOR LAKE PLUMBING PERMIT •
ioka
sem,,
PERMIT NO.
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1.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS- ZONING(office use)
..(04.5
flis S
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION pID
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(Name) ` a if/nC s (��if CL V 4- (Phone)6/V 7 " 6/3y
(Address) 54atoa
APPLICANT
(Name) appilance Connections Inc. (Phone)
12850 Chestnut Blvd.
(Address) shampoo, MN 55379
x.9545-4803 (City) .(Zip Code)
(Contact Person) , 44 i J / ' (Phone)
APPLICANT SIGNATURE 11/ . �r/ DATE /(0//e.)--//cr
, ,
APPLICANT PL ASE 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
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
The Minnesota Statutes§326B.148 $ Building Permit#
"SURCHARGE"has been extended
The minimum surcharge for a PLUMBING PERMIT FEE $
"fixed fee permit is STATE SURCHARGE $ L d
' ,D TOTAL PERMIT FEE $
�,no �Q. SU
This Application Becomes Your Building Permit When Approved Paid t R ipt No.1 C
Beier Official Date Dat .V1 _ t`�"
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24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372