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PLUMBING PERMIT 17-0004
DATE TIME CITY PRILAI '.� Imo] INSPECTIONOF OR NOTICEKE SCHEDULED ADDRESS OWNER CONTR. PERMIT NO. PHONE NO. 0 PLUMBING RI ❑ EX/GRADIFILLING ❑ FOOTING 0 MECH RI 0 COMPLAINT ❑ FOUNDATION 0 FIREPLACE RI ❑ FRAMING ❑ WATER HOOKUP ❑ FIREPLACE FINAL ❑ INSULATION 0 SEWER HOOKUP 0.GASLINE AIR TST ❑ FINAL 0 PLUMBING FINAL \/d°" 0 MECH FINAL Z �, n ❑ SITE INSPECTION \"1 �.'D�' COMMENTS: �iQ�ORK SATISFACTORY,PROCEED p CORRECT ACTION AND PROCEED 0 CORRECT WORK,CALL FOR REINSPECTION BEFORE COVERING Owner/Cont c Inspector. CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURSADVANCE. E SAFETY! CDE REQUIREMENTS ARE FOR YOUR PERSONAL HEAL "SNOT' ttr04 PRION Date Rec'd C CITY OF PRIOR LAKE PLUMBING PERMIT 13 ./ 7 4rsos� I. alae File z.cola city PERMIT NO./7_009 3.Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING(office use) J q -7O /ccs - ;j'f--ree (- J _ 02(Sl) LEGAL DESCRIPTION(office use only) . LOT BLOCK ADDITION PIDO - ,2LIS ( f -0 OWNER / !/ " littb (Name) LO rr (� X(€i (Phone) �7© (Address) 5 el --7 0 150/4- `.' l i'ee Se APPLICAN . (Name) t XC;�;-, - M f r:nea c-v..e it.6.ry t�} r , Fil NA (Phone) q 5dd-qt1' a tiiit/Li � (Address) _ I 2- 3 rum cl A . (57)Ai .Pg 5531 I (Address) (City) (Zip Code) (Contact Person) i es-3 C`` p - m NJ (Phone) APPLICANT SIGNATURE (J � DATE PLICANT PLEASE COMPLETE BELOW Quante Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwasher + Water Heater Floor Drain I 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 $ Z 1. 2 Building Permit# PLUMBING PERMIT FEE $ "f q` 0 STATE SURCHARGE $ TOTAL PERMIT FEE $ 0 (Office Use Only) This Application Becomes Your Building Permit When Approved Paid `7 Receipt Noi 1 Sl 5Jav�"" Buiidina Official Date Date 1 , 3, I/ By fr 24 hour notice for all inspections(952)447-9850,fax(952)447-4245 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372