HomeMy WebLinkAboutPLUMBING PERMIT 15-0021 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED ,I I j A'
ADDRESS 1 � `l 174
OWNER CONTR.
PHONE NO. PERMIT NO. �`� . C..)C;L)
❑ 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: -L° H-4 1Z
jLz
WORK SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
❑ CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING
Inspector: C Cia.p,---- Owner/Contr:
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH&SAFETY!
INSNOTI
19 - 2L/LI .
o4 VRto� Date Recd
N CITY OF PRIOR LAKE PLUMBING PERMIT
a'itvriEso*
' Blue
F'e PERMIT NO.
2.Gold City 2/ /
3.Yellow Applicantf
(Please type or print and sign at bottom)
ADDRESS u 2,Fs ZONING(office use)
T- -C6CCL nvc se
LEGAL DESCRIPTION(office use only) •
•
LOT BLOCK ADDITION HD
(Name)OWNER 1 r V-- Gl i (Phone) V! W
(Address) 1 Le -l. 26 fl-oca \vre �E
APPLICANT G'Cr\
K C /\(Name) 2 (Phone) JZ '/ C V
(Address) 2Z0o W 13 &um S S J J
(Address) (City) (Zip Code)
(Contact Person) (Phone)
3APPLICANT SIGNATUREr�/ /! DATE ZZ
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantit T e of Fixture
Bath Tub with or without shower
Dishwasher 0 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
The Minnesota Statutes FEE SCHEDULE
§326B.148 job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
"SURCHARGE"has been extended Residential,Additions&Alterations $49.50
The niinintuln surcharge for a
"fixed fee"permit is$5.00 $ Building Permit#
PLUMBING PERMIT FEE $ ( "l 'S�
STATE SURCHARGE $ XXL 5.00
TOTAL PERMIT FEE $ .SJ
(Office Use Only)
•
This Application Becomes Your Building Permit When Approved Paid 5 50 receipt No. /'�'�f 0
Bulidine Official Date Date "f !/
3
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 ,.
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372