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HomeMy WebLinkAboutPLMBG 06-0890 '1"..01 I I u,-- r~Jurt: LHKt:. ~::>':::44'(4dq::> 1-'.1:::11/1:::11 Date Ret'd I Blue FUll: 1, o.fd Ci<y j v.U.... """'i..., I PERMITNO.~. 890 l . ZONING (omceuac) C'&.,. LEGAL DESCRIPTION (oftla use only) LOT BLOCK ADDITION OWNERC.? (Name) 0/"<... y '" P1D /?7~:/" C>'n )' 0 /? (Phone) 7'5-:? -~X ~ 5b,1;:;2- (AddreSS) e::: z:, /'-> /' c7 /' --<c.~/;:e APPLICANT (Name) 5Z3~5.-?e ,/ /??e.e-.h~~ 'C'......./ ,2'""-'7c. - (phone) 9c5~ -..?5'P /600 /t/ e.4.-/ A "'-"<.- /?:7-'Z/ LSZ: c 7/ (City) (Address) /..5- '7""Y 3 /'a:: ,y-e., ..s'4---- S c =- ..2. . (Address) /? (Contact Person) ~,... ~ / (Phone) (Zip Code) 9,..~f::;';; -;::::;'-;. 'cP - ./= 0 C) APPLICANT SIGNATURE Quantity Type of Fixture QUADtity 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 / BackfIow Assembly Sinks Backflow Assemb.!y Test Bar Sink d- Lawn Sprinkler Water Closet (Toilet) Other APPLICANT PLEASE COMPLETE BELOW FEE SCHEDULE Industrial, Commercial'" Muhi-(amily 1% of job cost with 4 $39,54) minimum Residential. New On~ &. Two-FllITliJy , . ~ RosidentiaJ. Addi(ions &; Alterations 9'?..--; <V W- Estimated Cost S ..5 9 j!J J.:< 70 uilding Penn it # ./ $lJ950 $39,50 (OlI'lCt Uie O.'y) This Appliealion Becom~, Your 1I1IUding Permit Wben Appro\led PLUMBING PERMIT FEE S STATE SURCHARGE $ TOTAL PE:aMlT FEE $ 395-3 ~. .050 lJuildln~ Otlltlal D".. 24 bour outke (or all i1l1pecriQBs (IJS%) 447-9850. {ax (952) 447-045 16200 EaaJe Crllllk Ave.. S.[" Prior uklt, MN 5531:Z-1714 TOTAL P. 01