HomeMy WebLinkAboutPLMBG 07-0575
Date Rec'd
I. Blue File I PERM T ?r
;: ~~:~w ~:Iicant I NO. 01.0 ':)1 ~I
at bottom)
ZONING (office
use)
ADDRESS
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
Pill Z':;~03lJ. () i..2. ,0
OWNER ,.....
(Name) t'C'0~~,,- 'C \) r-- \ \) t' v'
(Phone) 9Sd-d-IJ..-d-7/L;
1 ~~ S {:.:
l(.)( ~ (e
';)-
APPLICA~
(Name)----J(l) fo'~ 12.cc:+ e r
(Address) 146 OC) c9-- 1 t Y\ A- 1J"f hJ
(Address)
(Contact Person) bu Ij --( Wj ~ 1 VY""lc.<- V\ It
(Phone)
:t> l'f \'Y\.o ,-", h
(City)
1~3-
(h\~,
"6 l'7r 37 () ~
CS!; VLI C
(Zip Code)
(Phone) l ~ 3 .- V i 7- J7()~
~ -d5 - tJ'7
APPLICANT SIGNATURE
e of Fixture
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 $ 5 ro.OO Building Permit #
PLUMBING PERMIT FEE $ '6 C-j, so
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ ~;,
(Office Use Only)
Date
This Application Becomes Your Building Permit When Approved
Buildinl! Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4 45
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714