HomeMy WebLinkAboutPlumbing Permit 16-1156 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED r0/4
ADDRESS / 7qL1 4'e
OWNER CONTR. (-A-7
PHONE NO. PERMIT NO. I(t ,( I t
❑ 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: Vi 2U
PC4---- -)
WORK SATISFACTORY,PROCEED
❑ ORRECT ACTION AND PROCEED
❑ CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING
Inspector: C�' .) Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
INSNOTI
C
Ip� Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT /0 _l (d
rsi
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i. sluew File PERMl✓ .. //56IT NO./6
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3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
479V ettef7q41 4e silt/
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) 4t/GI/9 C/€4e (Phone) =,-,L7— i5—
(Address) /‘129V 4 j7L%/, A ...fa
APPLICANT (-- &./A
i ' /„¢h /� / /k,'I
(Name} �/�/ L,GP//1-----7i„'///� fits' � G,/�wi'7` (Phone) ,_..vo :5322- ,,ne15-0
(Address) ,4 i /74-1;;X/09/ — 3.5r.)
(Address) (City) (Zip Code)
'—
(Contact Person) ,JD1'I /� (Phone) ..2;12-J77—...29..
APPLICANT SIGNATURE ‘_., f `9,,d111,,, DATE /e16
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 $ ,-)...0..)
STATE
STATE SURCHARGE $ $1.00
TOTAL PERMIT FEE $ _Sa,o
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid o y 5—z)
Receipt No. 704
Date�U. // 6. BY )��
Building Official Date
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372