HomeMy WebLinkAboutPLMBG 05-0998
THIS FILE HAS BEEN
CITY OF PRIOR LAKE PI CLOSED DUE TO
INACTIVITY 4/18/2008
REQUEST FOR FINA~
INSPECTION SENT TO
HOMEOWNER 01-06
lite Rec'd
File
City
... Applicant
I PERMIT NOoOS_ q 1 &J I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOTd3BLOCK ADDITION
OWNER
(Name)
ThDtnCcS
tY1L
APPLICANT I ~ \) '- <(
(Name) n r r I ~\rID(k J
(Address) ~~ r
(Address)
_ (Contact Person) --16= . SOl
,PPLICANT SIGNATURE
(Phone)
t=a~Cttl
. (CIty)
PID(J 1- 077
(Phone) Cf'j"d-l.Jtf 0--4'J-Of ()
N.553 ~
~\-3b7'-'~LfD
MAl. CSSld-~
(Zip Code)
(Phone) lcf) \~S~ \ ?:>LfO
DATE 21?-d-/o S
(Address)
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher I Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backtlow Assembly
Sinks REQUEST FOR FINAL Backtlow Assembly Test
Bar Sink SPECTION SENT TO Lawn Sprinkler
Water Closet (To IN - 6 Other
APPLICANT PLEASE COMPLETE BELOW
HOMEOWNER 10 0
.I' J'..L ~LHEDULE
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 $ ;L0 O. 0 0
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3~.~o
.50
LID' DO
_JOffice Use Only)
fhis Application Becomes Your Building Permit When Approved
Building Official
Date
Paid
Rece~06 t?O
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
40. (i)
CP
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