HomeMy WebLinkAboutPLMBG 07-0431
Date Rec'd
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I. Blue File I PERMIT NO I
2. Gold City . 07. 04-3/
3 Yellow Applicant ,
ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
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I OWNER
(Name)
(Address)
(Phone)
APPLICAN'V1. (\ ..-. ~
(Name) {~~;:n5 ---r:He YWtNviNcC r;(LfJvf
(Address) -.tJaC \ t\u(Ll Zqv..j \r14t-~ s-e
(Address) (City)
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A.PPLICANT SIGNATURE
(Zip Code)
(Contact Person)
(Phone)
DATE
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 , /1 Backflow Assembly Test
Bar Sink )<..J Lawn Sprinkler
Water Closet (Toilet) ( Other
LICANT PLEASE COMPLETE BELOW
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 $
TOT AL PERMIT FEE $
S 9.. S1J
.50
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(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid
4-6.00
Date &. If. 0
Receipt No. 53 J"b4-
Building Official
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
16200 Eagle Creek Ave., S.E., Prior Lake, MN 55372-1714