HomeMy WebLinkAboutPLUMBING PERMIT 16-1057 DATE TIME
CITY OF PRIOR LAKE
fi INSPECTION NOTICE SCHEDULED // (C(�
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OWNER CONTR.
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PHONE NO. PERMIT NO. l t S1
❑ FOOTING 0 PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOUNDATION 0 MECH RI 0 COMPLAINT
0 FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
❑ INSULATION 0 SEWER HOOKUP 0 FIREPLACE FINAL
)2LFINAL 0 PLUMBING FINAL . 0 GASUNE AIR TST
❑ SITE INSPECTION 0 MECH FINAL 0
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❑ WORK SATISFACTORY,PROCEED
CORRECT ACTION AND PROCEED
❑ CORREC • O• CALL FOR REINSPECTION BEFORE COVERING
Inspector. Owner/Contr.
CALL -9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
ODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
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Date Rec'd
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CITY OF PRIOR LAKE PLUMBING PERMIT
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"`"`` f'`` PERMIT NO, �j 7
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(Please type or print and sign at bottom)
ADDRESS„
+(8SD r`(t c-VA AYn,
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ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
O(Name) IIVIht't✓V Ck 1 p' 1
(Phone) (( 'I Z 3
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(Address) I IiiP50 Wit s '1) .1‘( ,,/ .f N( v
APPLICANT, ^�Y n' v�
(Name) IV 1 v
(Phone) 5 1 — Ala/ .....
(Address) 2129022X_ILIO I Y IVY b I Ce
(Address) (City)y) (Zip Code)
(Contact Person) LAC'
C�--11 (Phone)
APPLICANT SIGNATURE WW1 DATEZIL2141/0-1 0
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher V Water Heater
Floor Drain Water Softener
Lavatory(Bathroom Sink) _ Stand Pipe(Washing Machine)
Laundry Tray(I 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%01 job cost with a S49.50 minimum Residential,New One&Two-Family S 149.50
Residential,Additions&Alterations S49.50
Estimated Cost $ Building Permit#
PLUMBING PERMIT FEE $ 4-9 ,S 0
STATE SURCHARGE $ S1:00
TOTAL PERMIT FEE $-(0 ,S
(Office Use Only)
This Application Becomes Your Building Permit When Approved PaidRecei t No. / qi q 1
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Date By
Building Official Date q,, C, lit/ ti
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.F..,Prior Lake,Minnesota 55372