HomeMy WebLinkAboutPLMBG 05-1031
THIS FILE HAS BEEN
CLOSED DUE TO
CITY OF PRIOR LA INACTIVITY 4/18/2008
REQUEST FOR FINAL
INSPECTION SENT TO
I =:;S~:md.P"~ HOMEOWNER 01-06
/~/_~ .- h (b/A.I j- Rei g~
Date Rec'd
10. (+.0:;-
I. Blue File
2 Gold City
3 Yellow Applicant
I PERMIT NO. 5.103/ I
I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
PIDZS 03'1 004-. (J
(Phoneq~ JI-'/7-r2/%71
2~ .
I=~;;' ~4l{f/i;;-1</
"PLICANT SIGNATURE
(Phone) ~~4grv~C
c3~ t3'IPV/?II/)!c~ h?jJ~G~7
(City) (Zip Code)
(Phone) 9'5~--1~g-;. 7[i;'<J'tJ
~
APPLICA~ /f4 h
(Name) . rr-rrI.n j I'J /J 'fr. 'f?
(Address) j;;;;}-' I~;-h )+//e
(Address)
(Contact Person)
DATE
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher I ~ Water Heater , I
Floor Drain , Water SOffifer
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 C
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 $ ~e:;;-L/ q::!? ~uilding Permit #
PLUMBING PERMIT FEE $ ,39.50
STATE SURCHARGE $ .50
TOTALPERNUTFEE $ 1O.vo
(Office Use Only)
~his Application Becomes Your Building Permit When Approved
-
Receipt No. 503/
By
Paid
Date
Date" L 05
10.l~ ·
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