HomeMy WebLinkAboutPlumbing Permit 16-1218 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED
ADDRESS Lc-RS-
(� 't .0..
OWNER CONTR.
PHONE NO. PERMIT NO. 112_2_, /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 0 GASLINE AIR TST
❑ SITE INSPECTION 0 MECH FINAL ,,`"
COMMENTS: t42,0
DIS WORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING
Inspector e. Owner/Contra
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
matron
O�YRIO4 Date Rec'd
a, CITY OF PRIOR LAKE PLUMBING PERMIT •
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4ZIVNESC"'
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Blue File PERMIT NO. /6 _ /Z-/ e
2.Gold City
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
624 q3 6 5 Y) a
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
(Naame))RSIC Inay IAC Y r l'P> (Phone)�4� (O i' %( —1 o(z�
I
(Address) �Q tA
APPLICANT Appliance Connections Inc
e) 12850 Ciestnut Blvd. (Phone)
(Address) Shakopee, MN 55379
(Address) 952-445-4803 (City) .(Zip Code)
(Contact Person) _ L V 1 •• (Phone)
APPLICANT SIGNATURE all - - - ° / A l► i DATE 111
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture _ Quantity Type of Fixture
Bath Tub with or without shower Rom-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
The Minnesota Statutes§326B.148 $ Building Permit#
"SURCHARGE"has been extended PLUMBING PERMIT FEE $
The minimum surcharge for a STATE SURCHARGE $ _ L
"fixed fee"permit is
TOTAL PERMIT FEE $ /1 SO
This Application Becomes Your Building Permit When Approved Paid :630: Rece. t No.1 i
Date By
Buntline official Date l
24 hour notice for an Inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372