HomeMy WebLinkAboutPLMBG 07-0530
Date Rec'd
&~ II ,/7
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I. Blue File I PERMIT NO
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3 Yellow Applicant , {../ _
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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OWNER .
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APPLICANJ,.. \ '
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(Address)
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(City) (Zip Code)
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DATE ~.).. )- 0 1
APPLICANT SIGNATURE
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 I Lawn Sprinkler
Water Closet (Toilet) Other
A PLICANT 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 $
TOTAL PERMIT FEE $
Ji{ :'9,.>0
.50
L.{o. CI()
(Office lJse Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid /}tl_--
Date
Ct .lJ ..I
pt No. ~'f{/ '-Ie}
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714