HomeMy WebLinkAboutPLMBG 06-0386
Date Rec'd
I. Blue File I PERMIT NO I
2 Gold City . /) C 030,11
3 Yellow Applicant , L' l / t.
ADDRESS ZONING (office use)
5"5/() fJ-mbluutJtJt? D~ IV~
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID 2). II S-. 0 ~. 0
OWNER
(Name)
-rtJdtA -t 13 (Lr I::;
I~e S+ev
(Phone)
C} S 0- LfLts, 'b lj A
(Address)
APPLICANT
(Name)
S !tYJ.1l? irS ft~O~~
(Phone)
(Address)
(Address)
(City)
(Zip Code)
(Contact Person)
~.cub ~
(Phone)
\PPLICANT SIGNATURE
DATE
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 X Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
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 $
Building Permit #
(Office lJse Only)
This Application Becomes Your Building Permit When Approved
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
3 q.50
.50
Lit) ,nO
Buildinl!; Official
Date
Paid ..(tl, t' ()
Date S; 17 {It:,
Receipt NOB 40>5
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714