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('T""" ow PDTOD T .J\. KF. IN~~SED Dui ~~N
REQUEST FOR FINA~ TVrry 4/18/2008
INSPECTION SENT TO
HOMEOWNER 10-06
Date Rec'd
I. Blu. Fil.
2. Gold City
J . Yellow Applicant
I PERMIT ~\I. Oto ~ IS 31
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT '0 BLOCK J ADDITION
mrn Blvd (\)E f::x::j::n~
1m J- iJ<1
OWNE~
(Name) ~ Fvo..ns
(Address)
Pro) 5 -
-D
APPLICANT
(Name)
(Address)
CULLIGAN WATER CONDITIONiNG
6030 CULLIGAN WAY
MINNETONKA, MN 55345
(Addr'Qq2) 933~ I::!UO
(Phone)
(Contact Person)
(City)
(Phone)
(Zip Code)
.. .. PPLICANT SIGNA TV
DATE c.Y/r:;)~/0( 0
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain J 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
APPLICANT PLEASE COMPL 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 #
(Office Use Only)
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
.3=1.f5()
.50
4{).OD
This Application Becomes Your Building Permit When Approved
L \ Building Official
Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4 5
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714