HomeMy WebLinkAboutPLMBG 06-0878
Date Rec'd
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; :I~ ~::y I PERMIT NO. J\ (,. 0 8 -1d.
3 Yellow Applicant . V I ~
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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OWNER
(Name)
(Phone)
(Address)
APPLICANT \ "\
(JolOlliO) ~ f'. ~..... r ~ Q I " """ b. P
(Ad.dress) 3&~O tV: \\o~~~o 51-
(Address)
(Fh<>ne)
p,..~or
(City)
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L....k.'- ~S"3-, 1-
(Zip Code)
~"LICANT SIGNATURE
(Phone)
(Contact Person)
DATE
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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
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
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOT AL PERMIT FEE $
31. SlJ
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(Office lJse Only)
By
Date
Paid fa v-1J
Date Q ~b
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Receipt No.
This Application Becomes Your Building Permit When Approved
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