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HomeMy WebLinkAboutPlg Permit 02-1218 Jr3o~ :Jf (f({2j Date Rec'd PERMIT {j-Z(;-OZ- I. Blue File PERMIT NO I 2. Gold City "OL-/2/ . 3 Yellow Applicant (Please type or print and sign at bottom) ADDRESS ZONING (office use) LEGAL DESCRIPTION (office use only) LOT BLOCK ADDITION PID OWNER (Name) CoI/tIC C.. "!-/" j (Phone) (Address) APPLICANT J!j JJ-L . L/1 /1 I I~f (Name) !'/Ot}/Lr: ~ /"lctJllE //1.1'/.17 u""" (Address) . It) 3 56 ;). 9'1 TJ. 4-1/t (Address) IJ1-//F hC:iJllC / {'Jilf' (/l APPLICANT SIGNATURE /:/.Y Y ?f '/ /' APPLICAl\T'T' ~ SYt,C1:\O~O Typf' ,,~~ fOR \~ C'tOR. Bath Tub wit: RbQDt$~ CO~1:~St, f\\"t, Dishwasher St,~1: 1: ~St, _ C\., Floor Drain Rf,SyO 03 Lavatory (BathI ~p.,."'{ '10 Laundry Tray (1 _t'aIlment sink Shower Stall Sinks Bar Sink Water Closet (Toilet) (Contact Person) (Phone) 76 j.- :>,<1-7 -;2{:?.J ~-S- __77 / (Zip Code) 7t- 3;2Jf; -c-,/(/j- DATE cJ-';?-6 - (;-~ (Phone) p ;2/ ,vvcFI[~~ (City) Quantity ETE BELOW ~ Type of Fixture ~ Rough-ins Water Heater Water Softner Stand Pipe (Washing Machine) Sewage Ejector Backflow Assembly Backflow Assembly Test Lawn Sprinkler Other FEE SCHEDULE Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Estimated Cost $ Residential, New One & Two-Family Residential, Additions & Alterations Building Permit # () z -/7,..( y $99.50 $39.50 PLUMBING PERMIT FEE $ STATE SURCHARGE $ TOTAL PERMIT FEE $ yf J7) .50 #, c-</ (Office Use Only) This Application Becomes Your Building Permit When Approved f(;f71:J 0;. U . u L- Building Official Date paid~d. (/V Date '1~ z",tJ, ~Q L Receipt No. / 4-:Jo7l.!> By ~ U. 24 hour notice for alI inspections (952) 447-9850, fax (952) 447-4245 16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714