HomeMy WebLinkAboutPLMBG 05-0273
THIS FILE HAS BEEN
CLOSED DUE TO
INACTMTY 4/18/2008
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OWNER
(Name)
LEGAL DESCRIPTION !office us~)
..50 ~I OA II ~
LOT BLOCK U ADDITION
PLUMBING PERMIT
Date Rec'd
~. ~~~ ~~~ I PERMIT NO.()c:-. /)..3/
3. Yellow Applicant . ~ (2.1 .
ZONING (office use)
#a-
o
L.. V6 A..! dv (Phone) 9J.~_ 790-/702
APPLICANT PLEASE COMPLETE BELOW
ype of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
(Address)
APPLICANT
(Name)
(Address)
(Contact Pers
Quantity
(Phone)
(City)
(Zip Code)
-/ -C) S--
Type of Fixture
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
Lawn Sprinkler
Other
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 $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
3 Cf-S-O
.50
C/b.
Paid
L/tJ-
Date tl-//-
Recei~~/I d-/
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