HomeMy WebLinkAboutPLMBG 06-1003
Date Rec'd
II. ~.06
I Blue File
2. Gold City
3 Yellow Applicant
I PERMIT NO. ()(p. /003 I
ZONING (office use)
I Jb <;'1 t.J
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID zr: Zz,9. 6'.7. 0
I OWNER
(Name)
(Address)
(Phone)
APPLICANT
(Name)
(Address)Lc- JJ
(Address)
(Contact Person) (./~ b
\PPLICANT SIGNATURE ~'J~
(Phone)
16?:r 3If--ft)~
55J
(Zi
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 Lawn Sprinkler
Water Closet (Toilet) Other .:t:.cf ,J'Y'...^ vrn -tJ~I::'
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 #
(Office Use Only)
This Application Becomes Your Building Permit When Approved
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
39,50
.50
+0.00
Building Official
Date
Paid +a. QU
Date ( 0'
/ .,-. !t1
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714