HomeMy WebLinkAboutPlumbing 03-0840
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DATE TIME
" CITY OF PRIOR LAKE lo~k-cJ5
INSPECTION NOTICE SCHEDULED.
ADDRESS it, <?fJ/ O<./c"> ,~ ~Jv-
OWNER CONTR.
PHONE NO. PERMIT NO. ~-~'1i)
o FOOTING o PLUMBING RI o EXIGRADIFILLING
o FOUNDATION o MECH RI o COMPLAINT
o FRAMING o WATER HOOKUP o FIREPLACE RI
o INSULATION o SEWER HOOKUP o FIREPLACE FINAL
o FINAL o PLUMBING FINAL o GASLINE AIR TST
o SITE INSPECTION o MECH FINAL 0
COMMENTS: /~ .!h.-....... (VI (r/-z-.
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~K SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORRECT i )RK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: V If " )..~ ....~ner/Contr:
CALL 447.9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.,
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH of SAFETY!
INSNOTl
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CITY OF PRIOR LAKE PLUMBING PERMIT
D'Ate Rec'd
U . ?4-.o/
I, Blue File PERMIT NO
2. Gold City . /13 .' 0 810
3. Yellow Applicant V
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT Ii/BLOCK 5" ADDITION We;f7??{...~ P(J/v OJ ?-77-1
PIDz5 -308- 0'30 - C
OWNER
(Name)
. (Phone)
(Address)
'PLICANT SIGNATURE
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(Address)
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. (Phone)
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(City)
"S'$""1J:l
(Zip Code)
APPLICANT
(Name)
(Address)
(Contact Person)
(Phone)
DATE
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Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture I Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
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FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit # () 3.> 0 ~
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
5q~50
.50
HJ.~O
._..10ffice Use Only)
Building Official
Date
paid+o. CO
Dati. W ,0/
Receipt N:?f~~6 9
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By _'/
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'his Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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