HomeMy WebLinkAboutPLUMBING PERMIT 16-1387 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED i 'Z '1 ,(p
ADDRESS 5-6, • Ni c 4,,, CL,
OWNER CONTR.
PHONE NO. PERMIT NO. _ 1,L. ..,_22_8_1___--
❑ FOOTING 0 PLUMBING RI 0 EX/GRAD/FILLING
❑ FOUNDATION
0 MECH RI 0 COMPLAINT
❑ FRAMING 0 WATER HOOKUP 0 FIREPLACE RI
IREPLACE FINAL
❑ INSULATION 0 SEWER HOOKUP 0 FAEPLA AIR TSL
SLINE
la FINAL 0 PLUMBING FINAL
❑ SITE INSPECTION 0 MECH FINAL (.4COMMENTS:
WORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING
InspectorC
Owner/Contra
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
INSNOTI
o ,PRlop Date Rec'd
; \ CITY OF PRIOR LAKE PLUMBING PERMIT
' '''(/ I \'� 1 (` 20. ICOjNy
21. Gold City Blue File PERMIT NO. I - 137
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS Z NING(office use)
3568 Hickory Circle Road iLL5(3
LEGAL DESCRIPTION(office use only) �I �� [�/
LOT' BLOCK ADDITION i� ,� (ec c 111 '1[ `�> ID� L ` �' � D.c®
OWNER Nancy James 262-388-7315
(Name) (Phone)
(Address) 3568 Hickory Circle Road
APPLICANT Tri County Water Conditioning 952-447-2160
(Name) (Phone)
(Address) 5333 160th St. SE
(Address) (City) (Zip Code)
(Contact Person) Bill Corby 952-447-2160
(Phone)
APPLICANT SIGNATURE ��./ DATE 11/30/16
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 1 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 $ 41,5 C
STATE SURCHARGE $ $1.00
TOTAL PERMIT FEE $ ,
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid go 6`-) Receipt No. -7 5j s'
/
Date /( (`f By 9,4A)
Building Official Date (
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372