HomeMy WebLinkAboutPLMBG 06-0527
Date Rec'd
CI'
THIS FILE HAS BEEN
CLOSED DUE TO
INACTIVITY 4/18/2008
TNG PERMIT
:~ ~~~ I PERMIT NO. /) I .-'~ ~.'71
ellow Applicant , '-L-~ .J. c:7
ZONING (office use)
No r-fh wood 'f2-cJ.
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
-141-604 ()
OWNERb b
(Name) \ ""l'\"~ ~O() t
(Address) ~
(Phone) gtJ~ -44'}-31'15
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APPLICANT, 'p
(Name) \"l
(Address) .JId] 0
fY(~~S
j)odd Rd.
(Address)
(Phone) JJ5i:3-~-I~~O
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(Phone) 6~
~/Cj/Ob
DATE
\PPLICANT SIGNATURE
(Contact Person)
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain I Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backtlow Assembly
Sinks Backtlow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
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
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
~'3q. DO
.50
13q.~o
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
Building Official
Date
By
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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