HomeMy WebLinkAboutPLMBG 05-0996
THIS FILE fIAs BEEN
CLOSED DUE TO
INACTIVITy 4/18/2008
~~
'N....Eso'\
Date Rec'd
{ OF PRIOR LAKE PLUMBING PERMIT
s~e
REQUEST FOR FINAL
INSPECTION SENT TO
HOMEOWNER 01-06
~S OWVleV" :;59/
. ~~ilicanl I PERMIT NOot?S- '19t:, I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT BLOCK
ADDITION
/- O~ 8'
OWNER
(Name)
32M1t) Lve~ c '1 Jet
2- S ~) 'S ' t.-v1(., t:-12 0 t- ~
NORBLOM PLUMBING co.
(612-) 827-4033
2905 GARElEl.OAVE. so.
MIN~LlS. MN 55408
(Phone)
(Address)
5w
APPLICANT
(Name)
(Phone)
(Address)
PPLICANT SIGNATURE
(City)
(Phone)
(Zip Code)
(Contact Person)
DATE
093005
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher l Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor ') ~~ -- - . Sewage Ejector
Shower Stall REQUEST FOR FINAL Backflow Assembly
Sinks CTION SENT TO Backflow Assembly Test
Bar Sink INSPE Lawn Sprinkler
Water Closet (Toil HOMEOWNER 10-06 Other
APPLICANT PLEASE COMPLETE BELOW
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 $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
~JO
.50
LJl.2J?Q.
.. (Office Use Only)
This Application Becomes Your Building Permit When Approved Paid
Date
Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714