HomeMy WebLinkAboutPLMBG 05-1167
Oi PRI( THIS FILE HAS BEEN
.:~ CLOSED DUE TO
,,/_- ~ LJL INACTIVITY 4/18/2008
~NES~
~ LAKE PLUMBING PERMIT
Date Rec'd
1/. tj. 05'
I. Blue File
2. Gold City
3 , Yellow Applicant
I PERMIT NO. or; . I' It 1
ZONING (office use)
Rd.
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2-S. 1+1 .OT~ ..0
OWNER
(Name)
~'Q~r \-\ti'O\d
&.IC 1(6Crvl.
(Phone)
qQ;). 447' 4?JI\.34CL
(Address)
APPLICANT \Jt.lI\JI\...lJ) ~ (Pho~.~/-~~
(Name) AU€- ~
(Address) k \ d- ~
\'iU'\( ~~
(Address) (City) (Zip Code)
(Contact Person) ty~ '" (Phone) 5CLW (
',PPLICANT SIGNATURE "'- ~ . \ 0~
DATE
\
APPLICANT PLEA~ E ~OMPLETE 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) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall I 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
dJ
Estimated Cost $ J ~
Residential, New One & Two-Family
Residential, Additions & Alterations
$99.50
$39.50
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3i.!YJ
.50
LtD. 00
(Office lise Only)
This Application Becomes Your Building Permit When Approved
Date
Paid t!/tJ--
Date /-
/( 2-'J "c'I
Receip~,NO'5) J 1
By
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