HomeMy WebLinkAboutPLMBG 07-0335
Date Rec'd
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I ADDRESS
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I. Blue File
2. Gold City
3 Yellow Applicant
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I PERMIT NO. Ot. 0355/
I
ZONING (office use)
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID z..~. 30 z. 0' I. D
OWNER
(Name)
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(Phone) 9 $"'d J..{ k..\ 1 ~~
(Address)
APPLICANT ~ H ::
(Name) fA'). . \ V\J
(Addm,) ~ - ' : _ _~, ~\-'LJ
(Address)
(Phone) -1i ~ $? Le 8 ~ D J.. .
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(City) (Zip Code) .
(Phone) le. \ d.
(Contact Person)
5&). i I'M
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 I 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 Use Only)
This Application Becomes Your Building Permit When Approved
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
40. ()t)
.50
Building Official
Date
Paid~. .J7J
Date .
)./ . j
No. S~~
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
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