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HomeMy WebLinkAboutPlumbing 07-0980 Dak> Rec'd 1 Blue FlI~ I PERMIT 2'Jold Cay NO.o{.oaD.O '3 Yellow Apphcant 1 U /~'OV I ~iL -{ I1I1~D~ ZONING (office use) LEGAL DESCRlPTION (office use cm1y) LOT BLOCK ADDmON PID OWNER (Name) APPLICANA_(} " . r (Name)~~.s f' .s tjOc.r.YL6::S VlS-en 20301 ~0f\.L DI~1{,'~..,1.~; M~. t:;S3'~~ (Phon~q Q) LJ 1- L/ 4" e.;? 0 a- Mr}. ' /1 (Phone) (CJ 5':)) 2.33 - /1 $ 4 (Address) (Address) (Contact Person) (A dress) ']) a~ f:5~ <1 APPLIC ANT SIGN A TORE ItUJQ...,.. j (Zip Code) (Phone) (9 5 d. J Ll r L1 - 0 ~ 0 ~ DATE APPLICANT PLEASE COMPLETE BELOW o Quantity Type of Fixture Quantity Type of Fixture Bath Tub with or without shower Rough-ins Dishwashcr Watcr I katcr Floor Drain Water Softner Lavatory (Bathroom Sink) Stand Pipe (Washing Machine) Laundry Tray (1 or 2 compartment sink Scwagc Ejcctor Shower Stall Backflow Assembly Sinks Backflow Assemblv Test TIar Sink 1 Lawn Sprinkler Water Closet (Toilet) Other FEE SCHEDULE Industrial, Connnercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99,50 Residential, Additions & Alterations $39.50 _ (;1) Estimated Cost $ 1rf3':J.." Building Pemlit # PLU1\ilBING PER!\-lIT FEE $ 3q . ~ STATE SURCHARGE $ .50 TOTAL PERMIT FEE $ YD. - (om..... US(' Only) This Application Becomes Your Building Permit When Approved Dale Paid +0. Cl 0 Dot~ to, l O. 0 Recei tNo. S4-B2..S- B BuDdin!! Official 24 bour notice for aU inspections (952) 447-9850, fax (952) 447-4245 16Z00 Eagk Cn-d..An., S.E., P,'iu.' Lake, MN 55372-171"