HomeMy WebLinkAboutPLMBG 06-0069
THIS FILE HAS BEEN
CLOS Date Rec'd
CITY OF PRIOR LAK ED DUE TO ^
INACTIVITY 4/18/2008 ,,-t:h
REQUEST FOR FIl '^ ~~ WI I
INSPECTION SENT TO Ufo -' d 0
HOMEOWNER 1 0-06 ~L ~i~licanl I PERMIT NO. b &- 0~
~........
ZONING (office use)
.$' f-r~r:. -I
LEGAL DESCRIPTION (office use only)
LOTY BLOCK I ADDITION
PID
1:) ~ O{J~
OWNER
(Name) .st.",,,, LI4I!~oJoJ
(Address) V7~" mlA./'-h",,-cfit(e $'1-_
(Phone) tllJ -- '117 - & J ~ 7
APPLICANT
(Name) ('Uk r ..)
1:1 ,~
(Phone)
(Address)
(Contact Person)
(City)
(Phone)
(Zip Code)
,APPLICANT SIGNATURE
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
X Sinks OtJ)J}~07 Backflow Assembly Test
Bar Sink I U Lawn Sprinkler
Water Closet (Toilet) 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
l\ AA.....
Estimated Cost $ ~VlI
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid tJ.-
Date 1_ 3/ ~ () b
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