HomeMy WebLinkAboutPlumbing 03-0927
CITY OF PRIOR LAKE
INSPECTION NOTICE
ADDRESS
3'33.:).
OWNER
PHONE NO.
o FOOTING
o FOUNDATION
o FRAMING
o INSULATION
o FINAL
o SITE INSPECTION
COMMENTS:
SCHEDULED
WI'L.O u"re;.p
CONTR.
PERMIT NO.
o PLUMBING RI
o MECH RI
o WATER HOOKUP
o SEWER HOOKUP
o PLUMBING FINAL
o MECH FINAL
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~JY
u
DATE
TIME
e-4~
~
:'?./ 727
o EXlGRAD/FILLING
o COMPLAINT
o FIREPLACE RI
o FIREPLACE FINAL
o GASLlNE AIR TST
~ u.-... <;~
./
~ORK SATISFACTORY, PROCEED
o CORRECT ACTION AND PROCEED
o CORR W . CALL FOR REINSPECTlON BEFORE COVERING
Inspecto:
CA
Owner/Contr:
R THE NEXT Ifo/llPECnON 24 HOURS IN ADVANCE.
MENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
/NSNO"
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CITY OF PRIOR LAKE PLUMBING PERMIT
Date Rec'd
7.1f.o]
,- ~ease ~e or Print and sign at bottom)
I ADDRESS
3332- !{,),fd ftS>re$T
J. Bille File I PERMIT NO
'Gold Ci" '015 _,/;... 7- J
J, Yellow Applicant 1./7 V'
t!/ L i.-fe
;tJ tU '
I ZONING (offi" u>cj
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
I
J
OWNER - f {
(Name), -r73c/cJ
e~
.
(PhonepJ 7. ~$' ~ - ~ I ~O
, (Address)
<:Jltl/f.
APPLIC~ ." / A
(Name) !...1M"'''' JVlI!-..4;~ r tv.otP.:o,"1
· (J
(Address) ("I'f "VIi,d.b.t- ~ t()J(fv.~/fIL:SOtI1. I
(Address)
(ContactPersonill''''_lI\'~- iJ/ p
APPLICANT SIGNATURE ~ ~
(Phone)
pt,{ V .
(City)
7:;; OZ--- t:f7</-o z..o ~
~~2 r')
(Zip Code)
(Phone) ~
DATE ?-f/~()..3
v
Quantity
APPLICANT PLEASE COMPLETE BELOW
I Type of Fixture I Quantity I
I Bath Tub with or without shower Rough-ins
Dishwasher I I Water Heater
I Floor Drain I Water Softner
I Lavatory (Bathroom Sink) I Stand Pipe (Washing Machine)
I Laundry Tray (1 or 2 compartment sink I Sewage Ejector
I Shower Stall I Backflow Assembly
Sinks Backflow Assembly Test
I Bar Sink / I Lawn Sprinkler
Water Closet (Toilet) I Other
Type of Fixture
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
jl.-- -
Estimated Cost $ ~';;;)O
,
Building PellT1it # OJ-O f'z.-7
(Office Use Only)
,J This Application Becomes Your Building Permit When Approved
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.50
Building Official
Date
pai~ ,vU
Dat7 II. t;]
Receipt~9J
~j-
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714