HomeMy WebLinkAboutPLMBMG 06-0237
THIS FILE HAS BEEN
CLOSED DUE TO
CITY OF PRIOR L. INACTIVITY 4/18/2008
REQUEST FOR F H~AL
INSPECTION SENT TO
HOMEOWNER 10-06
Date Rec'd
:~ ~!~ I PERMIT NO. /) J '--"3 rfJ
Yellow Applicant . fL..(.2. c;;f ~
ZONING (office use)
tQ
LEGAL DESCRIPTION (office use only)
LOT '1 BLOCK ( ADDITION
euJ
51
PI~5-lq5' ., {)O
(Contact Person
~~~~A~ ~€CLLlCi~-H- e..
(Address) \ \ 02-q ~L '\L L.-R- .
~:~~~ C''LDly tbJ le~ 1 E:CJ)\.~hone)~ \.~ -mo &oCo I
(Address)~';~ Q.t\-I '4\ d ~ ~()L\ +tL\.CL~ lot 5L/b1lc
(Adc6-ess) (City) (Zip Code)
L (Phon;1lS ~& 21QLD"I
{)7:::::vt./~ DATE C9 7 {
(Phone)10 ~d '5 \ ~ C, \ ~ Co
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher Water Heater
Floor Drain I Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backtlow Assembly
Sinks Backtlow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50
Residential, Additions & Alterations $39.50
Estimated Cost $ / D ()
00
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
7S\ . sa
.50
L\tJ,DD
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
I Paid
Date
I ::ceiPt No
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714