HomeMy WebLinkAboutPLMBG 07-0336
Date Rec'd
~. ~~ ~!~ I PERMIT NO. 67,03.:50 I
3. Yellow Applicant ,
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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OWNER
(Name)
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(Phone) qs~ ~Jvj I '7;).Cj-,
(Address)
APPLICANT
(Name)
(Address)
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(Phone) LRId- ~LR~ ~ 1 ()-;)..
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(City)
(Phone) wId. ~Lo~ A{ \ D"d-
DATE
(Contact Person)
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APPLICANT PLEASE COMPLETE BELOW
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 \ Lawn Sprinkler
Water Closet (Toilet) Other
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 $ 1-6D .....
Building Permit #
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
-f-fI)Ql)
.50
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid ~ ' ~-V
Dater-. (c.{.;
L~O.qJ
W.
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E" Prior Lake, MN 55372-1714