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HomeMy WebLinkAboutPlumbing 07-0541 Date Rec'd 0.25.07 ~';;~s~:md,:"~m~ ._ I i<;-;.2 (/ ""-'0 _d:.(rf,Ul I. Blue File I PERMIT NO I 2 Gold City '01. 0 r~ 1-/' 3 . Yellow Applicant , --' ,,- _ ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) (Address) ~# y. Zt-....{).'" h/~Vlt'/Y (Phone) Y.5;z-~I6.~5.;J.1';:'" h1lc~ APPLICANT (Name) 5 c...,-# hl-f.1C.IS (Phone) f 5.;2 - 9' f" ,c/ - 2-..2-/..J- (Address) /5'C/?1..Z /-vt:?(> 7"1 YJlIcil (Address) /"A' ,?L't... /JR1LJ ~ .4#~E, /J'1 rV (City) 5'5"3 'z,;z.. (Zip Code) (Contact Person) -->:~ (.r! F:-c;, Y1 C /';; (Phone) <7.5.;2 - V~/o -d.?-/~ APPLICANT SIGNATURE DATE APPLICANT PLEASE COMPLETE BELOW 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 ]V Lawn Sprinkler Water Closet (Toilet) , Other 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 $ TOTAL PERMIT FEE $ .3 957.; .50 ftJ UV (Office Use Only) Building Official Date Paid 40. (i() Date ~>. 25". () This Application Becomes Your Building Permit When Approved 24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Ave" S.E., Prior Lake, MN 55372-1714