HomeMy WebLinkAboutPLMBG 07-0402
Date Rec'd
s. 1-3 ~ oS
~ ~~:;~ ~~~ I PERMIT NO. 07- u' 410' 71
) Yellow Apphcant , ~ ,
at bottom)
ZONING (office
use)
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5E
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID ZS-, 064. 0 ~s I I
OWNER
(N ame) D e1J b I'"L
m llJ /IS 7Y! 12.
(Phone) 7'5d- ;).:2.b - ;) 4 I cr
(Address) /bo'lS-
51: ~'-L/ /tve
5E
Z O/It A/,pl~ L
Pf-fl) (Phone)
)J.lj../ If ~ t.1L /J1 AI.
(efty) (ZIp Code)
(Phone) 6/;).- 3;;;>8-7Y.tJ8'
blJ- 3~8-7'6C> 8"
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APPLICANT SIGNATURE
DAlE ~bl/t)7
T PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dish,yasher Water Heater
Floor Drain Water Softner
Layatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall I Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial. Commercial & Multi-tamily 100 of job cost with a $39.50 minimum
Residential. New One & Two-Family $99.50
Residential. Additions & Alterations $39.50
Estimated Cost $ Building PerInit #
PLUMBING PERMIT FEE $ {~ 50
STATE SURCHARGE $
TOTAL PERMIT FEE $
(Office Vse Only)
This Application Becomes Your Building Permit When ApproYCd
Date
Paid .If ~_ (j 0
Date 5'. 25. 0
ReceiptNoSJ TZ. G
BuUdin!! Official
24 hour notice for all inspecQons (952) 447-9850, fax (952) 447 245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714