HomeMy WebLinkAboutPlumbing Permit 16-0032 CITY LADATE TIME
INSPECTION
OFPRIOR NOTICEKE SCHEDULED /e/-2104/
ADDRESS Jy��7 310e10;4
OWNER CONTR.
PHONE NO. PERMIT NO. /6 ^32
❑ 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
O FINAL 0 PLUMBING FINAL 0 GASLINE AIR TST
❑ SITE INSPECTION 0 MECH FINAL ❑
COMMENTS:
0(D SP. '
✓72LWORK SATISFACTORY,PROCEED
❑ CORRECT A TION AND PROCEED
0 CORREC K,CALL FOR REINSPECTION BEFORE COVERING
Inspector: Owner/Contr:
CALL 447 850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
/JVSNOTI
o� pRlap Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
-_..._ i" /5-11 ()
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NNESO�
,-Blue City i
Z. cola PERMIT NO. /6,49,
4
(Please typeor3. Yellow Applicant ,
print and sign at bottom)
ADDRESS ZONING(office use)
/V c5 o' 7 --e 4 1—Ci / 2,- R 1
LEGAL DESCRIPTION(office use only) //
LOT D UBLOCK p? ADDITION /1/././e)R ` 2 C 7 i'-‘-‘„),4A) PID R5- 3 ,2-023-0
OWNER..-- - A `' (Phone) 9 9 J
(Name) �?�!ri" /'�,�'�`� �c�s� "/1"6–
(Address)4 ,x7 "
APPLIC' ► iJ
(Name) I► s.r " / •`' - C (Phone r5 - . Z.
s �C
(Address) /l D � /7-r../ -2i 1` /r/I/r.�` ��-�� ,
(Address) (City) (Zip Code)
(Contact Person)
/ j �'i�'f'/ .+1 (Phone) �/,
APPLICANT SIGNATURE ! ._ iv ,illir,'■,.0„r %! 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 $ Building Permit#
PLUMBING PERMIT FEE $ 9..-SC)
STATE SURCHARGE $ $1.00
TOTAL PERMIT FEE $ � -�
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 0 kg3 Receipt No. 3
Dater (( �(/., By
Buntline Official Date \ S I 1\
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372