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Home My WebLink AboutPLMBG 06-0292 i ". :~":'I'iii. ;;,;[r?:i:;>::~~~;:'.:-; .. . ',:,::.J'.J)ate Rec'd' ',.; ,'!It; ~" .;l~': ~'~/,';:\~ ,"1iH~~ ~. ~1 ~ ;;'.:': j~; ~;;l_j\':, ;. ',:' ,':' ~. ......ift'!lftl~~ihr~i t ~L ~~~Iicanl I PERMI!N~t9t~~:q J; ZONINGcomc:euse) ". . .,. .' J '<~ i:"" J,',:.. , ,-i',' .,", Cove.."f SE LOT BLOCK ADDITION .f 3b LEGAL DESCRIPTION (office use only) OWNER. () (Name) nT'uu.. 1k:>~C\.~ (Phone) CiS d - 1'-1 (g . .53 5"0 (Address); C.c;'-~i Cr"v-t. APPLICANT J (Name)' .:5<c...~ .s.~ (Address) \ ;)'-\ lo q 'i'R\ ':<.~ P\">Mh J Z:"rc. '" ~v<- (Phone) 95J- 64'-j-1looo Jntact Person) (Address) ~ :::"C,UC'_jI (City) .5531? (Zip Code) I ~ "'PLICANT SIGNATURE (Phone) ~L DATE - i-f- 13-0(0 APPLICANT PLEASE COMPLETE BELOW 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 ./ "'ffackflow Assembly Test Bar Sink V Lawn Sprinkler I" ", ~" ,-,- .... ......, . p ",.,,, Water Closet (Toilet) Other '. -; '<-"'\'\'.;, '.' ".;. 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 ~ Estimated Cost $ Building Pennit # ~o&J PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ ,ce Useqnly) I "'his Application Becomes Your Building Permit When Approved \ . Bulldlns Omcial \ Date Paid ---- \ \ 24 hour notice for all Inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714 \ \ ./ -",-,:-;'..~-_..-_....,~-----_._._---_....,_...... .