HomeMy WebLinkAboutPlumbing Permit 10-1171 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED a�(��(1_ __
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ADDRESS �5�3 �QT'�p�'' � \l�1SL�
OWNER , CONTR.
PHONE NO. PERMIT NO. (�-- t(21
❑ FOOTING � PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOUNDATION O MECH RI O COMPLAINT
O FRAMING ❑ WATER HOOKUP O FIREPLACE RI
❑ INSULA710N ❑ SEWER HOOKUP ❑ FIREPLACE FINAI
❑ FINAL ❑ PLUMBING FINAL O GASLINE AIR TST
❑ SITE INSPECTION ,�MECH FINAL ❑
COMMENTS:
y,
� WORK SATISFACTORY, PROCEED
p CORRECT ACTION AND PROCEED
❑ CORRE RK, CALL FOR REINSPECTION BEFORE COVERING
Inspector: OwnedContr.
CALL 447-9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HEALTH �c SAFETYl
�vsnon
� pRrp Date Rec'd
� �� CITY OF PRIOR LAKE PLUMBING PERMIT
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�fNNES��P t. Blue File
r � �, PERMIT NO.
3. Yellow Appl�cant � � / /
lease or ' t and si at bottom
ADDRESS ZONING (ot�ice use)
5 �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�aWmTER� Qh � r�i� �C.{ (Phone) � r �� a ��
(Address) S, '�✓' � �Q S o�
APPLICANT
(Name) (Phone)
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(Address} �3�� =3�-1340
(Ad��'� �d Rd . (City) (Zip Code)
_���1,1�A�1 b5123
(Conta.ct Person) �1 (Phone)
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APPLICANT SIGNATURE ' -�'`�-� ��'' ' " DATE
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Fixture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato Bathroom Sink Stand Pi e Washin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
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
The Minnesota Statutes � 326B.148 �st $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $ •�Q
July 1, 2010, until June 30, 20i 1. STATE SURCHARGE $ , 00 -�$$—
The minimnm surcharge for a "t'ixed fee" permit TOTAL PERMIT FEE $ s
is �5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid �,( S U c ipt No. �� fl,�
M}�
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Date �. 2 G ' � y
Building Official Date � �
24 honr notice for all inspections (952) 447-9850, fax (952) 447-4245 �/ �
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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