HomeMy WebLinkAboutPLMBG 06-0044
u~~_ -- ---~- ~ . u..... "'T TTMBING PERMIT
THIS FILE HAS BEEN
CLOSED DUE TO
INACTIVITY 4/18/2008
Date Rec'd
I. /3J)~
I. Blue File
2. Gold City
3. YeUow Applicant
I PERMIT NO.00. 00 'f'+ I
ZONING (office use)
KZ-
:;2 -1--15 S7lJ ,vz;;e/CgJ'T r'/17?I'
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID2-~- .38 4- 00 ( 0
I OWNER
(Name)
(Address)
(Phone)
APPLICANT V
(Name) \.....
(Address) 10 2-5 [)
(Address)
(Contact Person) l 0 V t.s ~ \.' j j
'({\. .,.. V2- \- '"\
A..PPLICANT SIGNATURE
APPLICANT PLEASE COMPLETE BELOW
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
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
$
$
$
3150
.50 I
4tJ ,t~) X. /
.-
8+/0.:;:'
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid ~O. u-O
Date} .? : ;,.,
(,1- t. l.Y
Receipt No. .52)8 G S.
By
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