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PERMIT
Date Rec'd
~ r.07
PERMIT NO. 07 0100
ZONING (office use)
LEGAL DESCR1.t' nON (office use only)
LOT
BLOCK
ADDITION
OWNER
(Name) L, IIlda IH az.ecQ..VV\p
(Address) 15~54- Fre.IIVlOVl-t Ave.. vno \I' La.k.e-
PID z.S-. 2.-\'2-. 0 l r~ 0
_ (Phone) 4-tfo '" (0 4- 2- l
APPLICANT
(Name) Drah," :j:)r-o BU~l~ (Phone)
(Address) 8815 ZOq-f3;t St. W. Lakeville- MtJ 550Lf-+
(Address) (City) (Zip Code)
(Contact Person) ---J~:J ::rct.V"&OI.-1. So (Phone) q52 4<;.q "qq '1
APPLICANTSIGNATURE~~_ DATE 2.2807
L---/ APPLICi~ PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity I Type of Fixtu
Bath Tub with or without shower Rough-ins
Dishwasher r Water Heater
Floor Drain Water Softner
Lavatory (Bathroom Sink) Stand Pipe (Washing Mach
Laundry Tray (lor 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
I Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
I I Water Closet (Toilet) Other
re
ine)
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)
PLUMBING PERMIT FEE $
STATE SURCHARGE $
TOTAL PERMIT FEE $
,3Q .50
.50
W.oo
This Application Becomes Your Building Permit When Approved
Building Official
Paid 4fJ. JU
Date .--
Date 1 ,) . Li I
24 hour notice for all inspections (952) 447-9850, fax (952) 447~45
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714
I~
I Rec1rr No. 5 Z- 3 '71
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