HomeMy WebLinkAboutPLUMBING PERMIT 16-1058 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED `0' VP
ADDRESS t.-1 $ `) Lai r 4-4...z t c-k--
OWNER
2. -
OWNER CONTR.
PHONE NO. PERMIT NO. � ,. . f 5" -?
❑ 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 , &e/
COMMENTS: 4/2." -4 /
U 1e ) &
1
ORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING
Inspector. .4 _ Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
WSNOT/
O`� PRI0� Date Rec'd
/ �\ {
L r ��1t-,
� CITY OF PRIOR LAKE PLUMBING PERMIT
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1. Blue File
2. Gold City PERMIT NO. 76 c_ , 5
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
11913 Peeir-F;e,f Di. S E, �'ritc- 1.aL, mai e 537 Z
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION Pu')
OWNER rr /
(Name) -ei'kel �a,l/f5(�(/t (Phone) ('/?— 6I8- LOP-10
(Address) l 7 L 7, be e r-cf,e-ICJi Dr. <s E.
APPLICANT n 1951-31.05 �
(Name) champ(U n P b 1 f (Phone) -1 L-l0
(Address) _31...O10 Dodd kat. #I®® mn 55123
(Address) (C' ) G (Zip Code)
(Contact Person) L 1 19 C101 (Phone) (.013��J 134D
APPLICANT SIGNATURE _ DATE _91V/10
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher i 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 $ 00 t 0 b Building Permit#
PLUMBING PERMIT FEE $ `t • 5-0
STATE SURCHARGE $ $1.00
TOTAL PERMIT FEE $ S- 0 • 9 0
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 51� ,�/ Receipt No. in/�,`�r`.,
Date J U, ( By W mg,
Building Official Date �. �� c '�
24 hour notice for all inspections(952)447-9850 `i
'4646-Dakota Street S.E.;Prior Lake,Minnesota 55372