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Home My WebLink AboutPLMBG 06-0593 Date Rec'd r,t- ~=.. ~tiCOId I PERMIT No.Ob- q9f I ~~NJNG ("'" I ~;ud~:ad<<L LEGAL DESCRIPTION (office use only) LOT / BLOCK ! ADDmO ~=cVave #, ller '~ Pill C),qq-- I / (Phone) rsz - ZZ(f;- OJ 7.t9 (Address) ~ APPLICANT (Name) ~ ~\J\.J\5 \)J E..t') b €- (Address) lo' L\ 5@ l\\R Sw (Address) tJ~~\.J6 (Phone) t9 \ d . 80 \ - ~ to D \-\u:\-~ 5535D (City) (Zip Code) (Phone) (Contact Person) 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 o Residential, Additions & Alterations Estimated Cost $ , 002-- Building Pennit # PLUMBING PERMIT FEE $ ~q · 50 STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ 40 · 00 $99.50 $39.50 (OfIiee Use Only) Tbis Application Becomes Your Building Permit When Approved Paid if (), - -q-~ ReceiptN~1 ~0 : By BuDdine 0ffidaI Date Date 24 hour notice for an inspeetioos (952) 447-9850. fax (952) 447-4245 l{j200 Eagle Creek Ave.. S.E.. Prior Lake, MN 55372-1714 "---------~-,...---,,._.~-""--_.--"~~.~~..__..-.~~...,..,...~_.