HomeMy WebLinkAboutPLMBG 07-0528
Date Rec'd
~, 2.1. 01
~,~~~ ~~;y I PERMIT NO. 07-(6-2 .-.....1
3 Yellow Applicant . ~
4-Z-74-
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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I OWNER
(Name)
(Address)
(Phone)
APPLICANT
(Name) A'l."6J.::'b7u~ PL,.l71/fC7
(Address) .?~i~(I Ll/t U-d...,-<..~
(Address)
(Contact Person) D/nJ (k c.'i../ (;/"f
PLICANT SIGNATU~'
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(Zip Code)
4' (2- . <f?,r J. C; 2- -f-9
/
(Phone)
P (. J
(City)
(Phone)
c, .. l~ , - 0 1
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 'K) Lawn Sprinkler
Water Closet (Toilet) ...- Other
APPLICANT PLEASE COMPLETE BELOW
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 $39.50
Estimated Cost $
Building Permit #
(Office Use Only)
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
I .5Q.
'-{U--
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 4V
Date / ' I
l.;I 1 'L-'
R eipt NOS'-l o{ 6
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714