HomeMy WebLinkAboutPLMBG 06-0505
Date Rec'd
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~.::~ ~~~ I PERMIT NO.6/, . 0545) I
3. Yellow Applicant , 1O
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ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PIDZS. 91'. 4U. 0
OWNER
(Name)
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(Phone)
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(Address)
APPLICANT
(Name)
(Phone)
(Address)
(Address)
(City)
(Zip Code)
(Contact Person)
A.PPLICANT SIGNATURE
(Phone)
DATE
t . /Z-. 0 b
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 X Lawn Sprinkler
Water Closet (Toilet) Other
APPLICANT PLEASE COMPLETE BELOW
FEE SCHEDULE
Industrial, Commercial & Multi-family I % 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 $
(Office Use Only)
This Application Becomes Your Building Permit When Approved
Date
Paid~. q1J
Date &. / Z. t7 6>
Receipt No.
Building Official
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