HomeMy WebLinkAboutPLMBG 05-1244
THIS FILE HAS BEEN
CLOSED DUE
CITY OF PRIOR LAKE F INACTn~T 4/ITO
~ v ~ J. I V 8/2008
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 10-06
ADDRESS
~~\ ~ W~~ \')d ~
late Rec'd
\
I. Blue File
2. Gold City
3 . Yellow Applicant
I PERMIT NO.05./Z44-\
ZONING (office use)
NW
s ') 3/ ~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID .Jr. l37. O( f. 0
OWNER"", c\ ~ '
(Name) ~~(\ . c..\l ,
(PhOne)qSJ.- lillO -577 "
(Address)
CUI LIGAN WAf t;H CuNun I\.h'vi\''l~
- 6030 CUll'G~N WAY
M\NNETONKA, MN 55345
(Address) (~52) 933 7200
(Phone)
APPLICANT
(Name)
(Address)
(City)
(Zip Code)
(Contact Person)
(Phone)
A.PPLICANT SIGNATURE
DATE
S~1/-0)
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 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 $ ;(O(J 60 Building Permit #
PLUMBING PERMIT FEE $ ~ ~, 56
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ Ll 0 0(')
(Office Use Only)
Date
Paid -10 _
Date
rz.zl.pj
Receipt No. ~
S7J~7/
By
This Application Becomes Your Building Permit When Approved
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714