HomeMy WebLinkAboutPLMBG 07-0804
CITY OF PRIOR LAKE
INSPECTION NOTICE
SCHEDULED
ADDRESS J 5 tto I
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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:
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DATE TIME
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o EX/GRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
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- ~.
~RK SATISFACTORY, PROCEED
o CORRECT ~ION AND PROCEED
o CORREC{Wo'd. CALL FOR REINSPECTION BEFORE COVERING
Inspector: ,
Owner/Contr:
r .
-~FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
,CALL
INSNOTl
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETYl
CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
<6. Z L 07
(Please type or orint and sign at bottom)
ADDRESS
15101 *ij hlltnJ Av~
L Blu. Fil. PERMIT NO. 07.0 00.A.
2. Gold City ~
3. Yellow Applicant
fhD{la.k~ 50312
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 25, 14-:$.0 Ie. 0
OWNER
(Name)
5f{.uV{)Al \Nal he,
( '\ atY\O ,
(Phone) TI~- tf!-:t7 -804~
(Address)
APPLICANT
(Name)
Champion
651-~5 1340
3670 Dodd Rd. #100
Eaaan, ft4N ~S1'\3-1339
(Addres~
.kv r~ 0 l.e~
(Phone)
(Address)
(City)
(Zip Code)
(Contact Person)
APPLICANT SIGNATURE
(Phone)
DATE
p)-u -D '}
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
I Dishwasher I Water Heater
I Floor Drain I Water Softner
I Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
r Laundry Tray (lor 2 compartment sink Sewage Ejector
I Shower Stall Backflow Assembly
r Sinks Backflow Assembly Test
I Bar Sink Lawn Sprinkler
I Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum
Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $
Building Permit #
(Office Use Only)
This Application Becomes Your Building Permit When Approved
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
31- 50
.50
'10. ()~
Building Official
Date
Paid
41) ~ 6V
Date e. u ~ d 1
/7
I R?tNO'54<7J
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714