HomeMy WebLinkAboutPlumbing Permit 11-0161 DATE TIME
CITY OF PRIOR LAKE
INSPECTION NOTICE SCHEDULED 3 �0 (�
ADDRESS c�U c3 � �J,[ �
OWNER CONTR.
PHONE NO. PERMIT NO. l��` C�Q, I
❑ FOOTING � PLUMBING RI ❑ EX/GRAD/FILLING
❑ FOUNDATION ❑ MECH RI p COMPLAINT
❑ FRAMING ❑ WATER HOOKUP � FIREPLACE RI
❑ INSULATION ❑ SEWER HOOKUP ❑ FIREPLACE FINAL
❑ FINAL ❑ PLUMBING FINAL ❑ GASLINE AIR TST
❑ SITE INSPECTION ❑ MECH FINAL � .Qer �} �
COMMENTS:
�
�WORK SATISFACTORY, PROCEED
❑ CORRECT ON AND PROCEED
❑ CORRE , CALL FOR REINSPECTION BEFORE COVERING
Inspector: OwnedContr:
CALL 9850 FOR THE NEXT INSPECTION 24 HOURS IN ADVANCE.
CODE REQUIREMENTS ARE FOR YOUR PERSONAL HEALTH & SAFETY!
INSNOT!
� O � p Rip� Date Rec'd
� � CITY OF PRIOR LAKE PLUMBING PERMIT 3(( � �
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� «�„�� �,��� pERMIT NO. �� � �O �
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;. Ycllow Applicant
Please e or rint and si n at bottom)
ADDRESS ZONING (ofe�ce use)
� c�,��l k. (� � d `. I� i c�r l�c�.K �
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
� �� �'��/\/ ` / �-1���' (Phone) / Jc� l��' � ! y
(Address) - 5 � 3 /
APPLICANT
(Name) �,i sgrt�ral�r► �'Iw�rtbir�� (Phone)
# .�177Q-PM
(Address) ���3 -36�-1340
35(�H�@�#�i Rd. (City) (Zip Code)
F3g�x�, MN 55123 1 z
(Contact Person) 1 � � (Phone) (E> �.� � — ✓ �� ^ ( � �
APPLICANT SIGNATURE DATE V� f
APPLICANT PLEASE COMPLETE BELOW
Quanti Tv e of Fixture Quanti T e of Fixture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavator (Bathroom Sink Stand Pi e(Washin Machine
Laund 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
FEESCHEDULE
[ndustrial, Commercial & Multi-family 1% ofjob cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
" ' ' "�st $ Building Permit #
The Minncsota St�tutes § 3266.148
"SURCI IARG1�:" h<�s becn changcd f'or onc pLUMBING PERMIT FEE $ t�
vcar eflcctivc
Jul�� I, 2010, u��(il Junc 30, 201 I. STATE SURCHARGE $ � .SO
"1'he minimum surchar�e for a "�xccl fec" permil � TOTAL PERMIT FEE $ ' C �
is S�, bcginnin� July I. 2010
This Application Becomes Your Building Permit When Approved Paid �� �� Re ' t No./_ �� ��
, lQ
Date / / ' / /
Buildine Official Date �• �Q ! '
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372 � DI� ��
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