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THIS FILE HAS BEEN
CITY OF PRIOR LAKE PLU1 CLOSED DUE TO
INACTIVITY 4/18/2008
REQUEST FOR FINAL
INSPECTION SENT TO
(pleasetypeor rintandsi at bottom: HOMEOWNER 10-06
[\~~~q ~'b\~ ~ ~ St
Rec'd
I. Blue File
2 Gold City
3. Yellow Applicant
I PERMIT NO. Ob./Z4~
I
ZONING (ofliceuse)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID c1 r. 0 17 . 040 . 0
OWNER
(Name)
\..:Jct-\~.kw ""
(Address)
/'
APPLICANT
(Name)
APPLICANT SIGNATURE
(Phone)q)d '44 t - LiG I
(Phone)
DATE
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 \ Water Softner
Lavatory (Bathroom Sink) I 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
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 $ ~ CD' Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
$ ~~. 56
$ .50
$ --=8 () - 00
Paid ~tJ _
Date Iii ,,~'
/2 -Z-v.vt
Receipt No. .!::>~ 6 f1
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714