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CII -( OF PRIOR LAKE t~ ~
clbf!mtJWM'&iMffoN'NG # .J2J-~l-
AppIlCWlt ~,,~o ~I " I I~AN WAY PhOne: ..",,,/!'
Address: MJNNr IlJNKA. MN 55345 fll'f/!J),
Signature: {R12) 933-72QO ' . .
legal Qescr1ptlon: Lot I r Block I Sub t1 ~ r-..I V\J A:T6R... 6 ~
SlteAddress:E-S0-J 6r"('){')kt:;;. id..f' I-N IV iV (.37.2)
BuUdlngPennit'. 0/ - 003~ ,Plo, 2.5..2107.... ()ll-O .
NOTE: This to' 010... ,:1 wtU not be p. ~ .....Aed ~ complete Information. .
FIXTURE UNITS
Type of Fodure Quantity Type ofAxture
4)
~
ntc-.,.....~
r
Bath Tub with or withOut shoWer
Oishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment link)
Shower Stall
Sinks
Bar Sink
WatBr Closet (toilet)
Rough-ins
Water Heater
WawrSoftner
Stanc$ Plpe (washing machine)
Sewage Ejector
BaddIow ~ (RPZ. 00cJM Check. PVB)
8ackftow AIHmbIy Test
Lawn Sprtnkler
Other
FEE SCHEDULE
Industrial. Commercial & Multi.Family
(1% of job cost, $39.50 minimum)
Residential. New One & Two Family
Restdential. Additions & Alterations
State Surcharae
$99.50
$39.50
$.
$-
s-~q. 6-[)
$ .50
GRAND .u.AL
s 40 g!l
)(lQ tIIo ~ c:ooditiocl dial said
_......... snau .'ij#Jfi"""'" .iU all.,. ... ...' widl tbe ordi-
oftbe StatlI PluznblD8 ,,,. .". .". ."...,;, .... ~'.
3~7B . k2A--Of DA1'E
ATTEST
Call fur all ~ 24 bows in advance.
16200 Eagle Cree~Av. S.E.. Prior Lake, Minnesota 5S372/ Ph. (612) 447-4230 I FAX (611) 447-4245
An Equal 0" "..usity Employer
~
~rooks~~
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS
/5.05"(
OWNER
CONTR.
PHONE NO.
PERMIT NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
COMMENTS:
TIME
4 : ()(J
6 I -D 0 11
o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o ~~SLlNE.AIRA!..
, ""~O ~T
.
[~\ I
J 'I n
1 '-- \ '---'
~ /. - C'
Uu'~~
/
~ORK SATISFACTORY, PROCEED
o CORRECT ACT~N AND PROCEED
o CORRW W~ . CALL FOR REINSPECTION BEFORE COVERING
Inspector: f;J \ ~ Owner/Contr:
CALL 447-9~50 FOR ~E NEXT INSPECTION 24 HOURS IN ADVANCE.
INSNOTI
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!