HomeMy WebLinkAboutPLMBG 07-0531
Date Rec'd
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I. Blue File I PERMIT NO ,
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ZONING (office use)
LEGAL DESCRIPTION (office use only)
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ADDITION
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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
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 lJse Only)
This Application Becomes Your Building Permit When Approved
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
s-o
30).
.50
'-10,00
Building Official
Date
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24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714