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HomeMy WebLinkAboutPLMBG 07-0558 Date Rec'd /2- {/7 ; ~~~~ ~:~ I PERMIT NO'6 7. 1/ h~-nl J Yellow Applicant , ...... ---' ~ 4- 7/ tp, ZONING (office use) 'IOW~ :;:;r: LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID I OWNER (Name) (Address) (Phone) APPLICANT (Name) L4k.., o/J /k PI//J>-v I> / Y7 5 (Address) I 7/ /ft 5$,/ ~,... A,.J> (Address) (Phone) Pc,&'iA-tl '" 1J.1o,..... (etty) 9' 5J-B9.;l -00 (P"<- M./"'I S5~:J<:) (Zip Code) (Contact Person) (Phone) ..sa V'-"- -( APPLICANT SIGNATURE DATE 7- J -0"7 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 j3ackflow Assembly Test Bar Sink ~ Lawn Sprinkler Water Closet (Toilet) ., Other PPLICANT 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 $ TOT AL PERMIT FEE $ 3ft ..ill .50 4-t', .:.V Paid ~ ,1,. (tv Building Official Date Date ..-, I z......j 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714