HomeMy WebLinkAboutPLUMBING PERMIT 16-1316 C./
TIME
(v/ DATE
CITY OF
PRIORNOTICE LAKE SCHEDULED
00..k,INSPECTION
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ADDRESS CONTR.
OWNER
PERMIT NO. 1 ❑ GRADIFILLING
PHONE ❑ COGRADIFI
0 PLUMBING RI ❑ FIREPLACE RI
❑ FOOTING 0 MECH RI 0 FIREPLANE
0 WATER HOOKUP
0 FOUNDATION
0
SEWER HOOKUP 0 GASLINE AIR FINALL
❑ FINAL INSULATION 0 PLUMBING FINAL 0
❑ FINAL
0 MECH FINAL
❑ SITE INSPECTION
COMMENTS Wa0
11
-WORK
SATISFACTORY,PROCEED
❑ CORRECT ACTION AND PROCEED
•RK,CALL FOR REINSPECTION BEFORE COVERING
❑ CORRECT •
pwnerlContr.
Inspector 41 __________-------
�i�� HOURS IN ADVANCE.
ANCE.
•
CA 447'9850 FOR THE NEXT INSPECTION
HATH&SAFETY!
CODE REQUIREMENTS ARE FOR YOUR PERSONAL
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4 PRipOCD Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
F
V
I. Blue Fik
2.Gold City PERMIT NO. /6, - (,3 (G
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
13641 CO1 MM 0016s re: /U) - 553-7 '�
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER , ,,f
U
(Name) `—>l "N A"I�l (Ze -e 0 "t (Phone) eVc; '308- 04
(Address) Sl' Vika
APPLICANT
(Name) Appliance C ur li it;_t►ons(9ne)
(Address) 12850 Cl�e sti ut Blvd
5
3h 3
(Address) akvpee, MN City) (Zip Code)
952-445-4803
(Contact Person) ) i0 f _ 19 ( (Phone)
APPLICANT SIGNATURE i,t)/L DATE
11
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
IndusMal,Commercial&Multi-family 1%of job cost with a$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
The Minnesota Statutes§326B.148 $ Building Permit#
"SURCHARGE"has been extended
Q
The minimum surcharge for a PLUMBING PERMIT FEE $ lit_
"fixed fee permit is$r, -813' STATE SURCHARGE $ I a,
1,ve, TOTAL PERMIT FEE $ 0
This Application Becomes Your Building Permit When Approved Paid 5-0 R ipt No. A,,- --'�
Date
Buntline Official Date i ,CI . ((' B
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372