HomeMy WebLinkAboutPLMBG 06-0507
Date Rec'd
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~.:~ ~:;y I PERMIT NO. 0".0507 I
3. Yellow Applicant , _
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
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BLOCK
ADDITION
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. (Address)
(Phone) Cf5z, 11/7. !XfY?
APPLICANT
(Name)
(Phone)
(Address)
(Address)
(City)
(Zip Code)
(Contact Person)
A.PPLICANT SIGNATURE
(Phone)
DATE {p ./2. Ci.p
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 f"-. 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 $
..s 9. stJ
.50
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(Office Use Only)
This Application Becomes Your Building Permit When Approved
Building Official
Date
Paid ~
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Date ~ Jz.. 0 (p
Receipt No. 5/S 7J
By
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714