HomeMy WebLinkAboutPLMBG 06-0826
THIS FILE HAS BEEN
CITY OF P! CLOSED DUE TO
INACTIVITY 4/18/2008
REQUEST FUK 1'll'U\L
INSPECTION SENT TO
HOMEOWNER 10-06
Date Rec'd
MIT
9./Z;Pt,
'-
I. Blue File
2. Gold City
3 Yellow Applicant
\ L\S-~'
I PERMIT NO. ~,. 082h I
I ZONING(_~) I
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
PID
OWNER
(Name)
--
\ 0 rv",.
~I
<Ls ~ Ie
(W ~. 4ve
~~
(Phone)
Qst-4LJo-fu-1
(Address)
~
APPLICANTCl .
(Name) -~~f ~,
(Address) 2....\ 2- f'...j {I.. , ve..,---
(Address)
(Contact Person) \) ~
A..PPLICANT SIGNATURE
)f2.[\J;~S ~C (Phone)
e{~e.- c- .fr
(City)
(Phone)
q)) - l{JS--1890
bu\ k- 5"S-3"5 r
(Zip Code)
C;):> - t./)J-7tB9o
7-l2~~~
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher J Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly. Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
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 #
(Office Use Only)
This Application Becomes Your Building Permit When Approved
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
S~ .sd
.5000
40.
Building Official
Date
Paid +a ~ c/l)
Date ~ 12. (j /,
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Aye., S.E., Prior Lake, MN 55372-1714