HomeMy WebLinkAboutPlumbing Permit 11-0094 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED 3 I�
ADDRESS C���� � � � � �((](� (�} Q� �'��
OWNER CONTR.
PHONE NO. PERMfT NO.
❑ FOOTING ❑ PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOUNDATION ❑ MECH RI ❑ COMPLAINT
0 FRAMtNG ❑ WATER HOOKUP ❑ FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL O PLUMBING FINAL ❑ GAS iNE AIR T T
❑ SITE INSPECTION ❑ MECH F1NAL � �_
COMMENTS:
i
1�1�(,ORK SATISFACTORY, PROCEED
�O CORRE TION AND PROCEED
❑ CORR�CT W , CALL FOR REINSPECTION BEFORE COVERING
Inspector: ', OwnedContr.
CALL 0 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTSARE FOR YOUR PERSONAL HE.9LTH dc SAFETY!
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. � pxip Date Rec'd
� �� CITY OF PRIOR LAKE PLUMBING PERMIT ���+. I I
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1 Blue File pERMIT NO . ��` //
2 Gold C�ty .y
3 Yellow AppUcant � r�
ease or ' t and si at bottom
ADDRESS ZONING (oflE'ice use)
5 �� eW f• ��--
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
�a ) �s�Cd�l � � (Phone) 1 �2 T ! 7' � CJ"1�
(Address) � ( , � J J � 2
APPLICANT
(Name) Champlon Plumbing (Phone)
(Address) 851-365-1340
E gan; 55123 (City) (Zip Code)
(Contact Person) 1,'� � `J (Phone) �(/� JI ���(1� �
APPLICANT SIGNATURE DATE ` ���I I
APPLTCANT PLEASE COMPLETE BELOW
uanti T e of Fixture Quanti T e of Figture
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
>st $ Building Permit #
The Minnesota Statutes $ 326B.148
"SURCHARGE" has been changed for one pLUMBING PERMIT FEE $ '�
year effective STATE SURCHARGE $ , (�--59
July 1, 2010, until June 30, 2011.
The minimum surchxrge for a "tixed fee" permit TOTAL PERMIT FEE $ _
is �5, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid � � Recei o�,� ^��
7 c��
Date / //� `/ By
Building Official Date ` •
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 �('�/�
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 �rW