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HomeMy WebLinkAboutPLMBG 06-1040 Date Rec'd 11.11" ()f, ; :I~ ~::y I PERMIT NO. /~. I ~~ol J. YeJlow Applicant . tP . ZONING (office use) /52f1~ FIlleW"Y IffS'. LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID zs: $7" (}l6. 0 OWNER (Name) (Phone) (Address) APPLICANT~ d E\ ' (Ii.....) '<<..-\rrl' i\\:. W"I\ 10 , ~ (Address) ~tb ~ () W . ,--,,\Io3()t\d ~ a..:t- . (Address) (phone) ct~ ;l" t-f '-/1- S I ~ ) 'fv,'Nrta. ~ S-S6,d. (City) (Zip Code) :iPLICANT SIGNATURE (Phone) (Contact Person) DATE 11- 11-0<-:' 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 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 # ( \ \ PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOT AL PERMIT FEE $ (Office lJse Only) This Application Becomes Your Building Permit When Approved Building Official Date Paid 1<J.. ",c,- Oate II.. t1 r (IV iptNooz-~r 24 hour notice for al\ inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714 - ~-,-,. ._"'.,.-+-<,._-_.,_...__._~.....~>.""---"--~,.-