HomeMy WebLinkAboutPLMBG 07-0710
Date Rec'd
1- Blue File PERMIT NO
2. Gold City . 01,0'7'.0.
3 Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS
160.9, PrltyLWkr (lirde,
LEGAL DESCRIPTION (office use only)
ZONING (office use)
LOT
BLOCK
ADDITION
PID
OWNER
(Name)
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\SaCfl 8&ttwakY 0((lr
~YiO\l W~_
(Phone) q6 ~ - 441.-, gSO ~
~ tJ r:B57'7r-
(Address)
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(Address) ~tf\o H-llYvld ~ .~.'1tIQ) ~iV1(I:A", HJJ 554')0
(Address) . . --(d1;),' ~ (Zip Code)
(Contact Person) ~ \ \ ill~ (Phone) qC;A~&g J.- ~~
APPLICANT SIGNATURE tl~([). ~
DATE
Quantity
APPLICANT PLEASE COMPLETE BELOW
Type of Fixture Quantity
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (Bathroom Sink)
Laundry Tray (lor 2 compartment sink
Shower Stall
Sinks
Bar Sink
Water Closet (Toilet)
Rough-ins
Water Heater
Water Softner
Stand Pipe (Washing Machine)
Sewage Ejector
Backflow Assembly
Backflow Assembly Test
l
I
1
1
I
I
1
1
I
Lawn Sprinkler _ 1
I Other \JtJJ.,J.lUrn b--.(l1.l.(y fUv I
i Y" Y '9ttfj OY'-
Type of Fixture
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 $ 5[)(J.LD
Building Permit #
PLUMBING PERMIT FEE
STATE SURCHARGE
TOTAL PERMIT FEE
$ :~q.SO
$ .50
$ LflJ . (1\)
(Office (Jse Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid 4-tJ. il ()
Date ~
D.I.07
Rf?' No 5+~fif
,f!
()
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714