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HomeMy WebLinkAboutPLMBG 05-0478 Date Rec' d ~ ~~~ ~:;y I PERMIT NO./;,_.?:)--- - J J?O 3 Yellow Applicant (L.."__ , ~ ZONING (office use) q /7 rJ-.CJ C-eJ' Itl/C LEGAL DESCRIPTION (office use only) 0 r LOT BLOCK ADDITION ~~L {i~~ PID /I,y~ t:Jo-3 OWNER G I (Name) "c.. Ie... Pi Ix... 7. J1 u(til I ~ { 2-0 (Phone) (Address) 5 L::' APPLICANT 1 j " I (Name) I+s. Cf'f( (Ii .t.( ~ (Address) t)Lj~-)~ -1<'(9 -j-t1 (Address) (Contact Person) ~ h "\. (J (J{ L.,ri1 ~i '/cy 5,;... ~v (Phone) (~) S' J-f{fo3 0 G\l2.... (City) (Zip Code) (Phone) ( 'S I, elt '3 - o() 7.<. <\PPLICANT 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 Backtlow Assembly Sinks "- Backtlow Assembly Test Bar Sink .A 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 # 3 C/. c;-o PLUMBING PERMIT FEE STATE SURCHARGE TOTAL PERMIT FEE $ $ $ (Office {Jse Only) This Application Becomes Your Building Permit When Approved LJO .50 ~ Building Official Date Paid L' ___ If) / Dat:2e - & r-' ~ 7 ":::> ~ -- 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714