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PLMBG 05-1132
~ TI-IIS FILE HAS BEEN ,: Y /11\ '\, CLOSED DUE TO '-'-I LJu INACTIVITY 4/18/2008 ~NES~ Date Rec'd ..AKE PLUMBING PERMIT II- 9..05 ~. ~~ ~:~ I PERMIT NO. "e:-. //.'32-1 3 Yellow Applicant . V::...J. ZONING (office use) F\~ LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID zS. O{ '7. I O~ ~ l) OWNER (Name) A\J\5 Jo\A.V\5OI\. ~oY\^-f (Phone) q5d -tt 41-dD3{ (Address) APPLICANT (Name) (Address) 'Wfd~ ~ It,\4 3fLO f\u-e fuJ (Address) (Contact Person) fJ .PPLICANT SIGNA TURE~ l)tv\Jt\.CS (Phone) l.o'd-~D' - 5~ \iLl~ 55366 (City) (Zip Code) (Phone) ~ DATE 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 \ Backflow Assembly Sinks Backflow Assembly Test Bar Sink Lawn Sprinkler Water Closet (Toilet) Other APPLICANT PLEA OMPLETE BELOW FEE SCHEDULE Industrial. Commercial & Multi-family I % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50 Residential. Additions & Alterations $39.50 Estimated Cost $ ,~ Building Permit # PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ 3Cf ,Cf) .50 t.t 0, ctJ (Office lJse Only) This Application Becomes Your Building Permit When Approved Paid 40- Receipt NO~37 5' 8 Date Date 1/. I 0 .0(' 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