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Quantity
11)/L
CITY OF PRIOR LAKE
PLUMBING PERMIT
----
1. Blue
2. Gold
3. Yellow
File
City
Applicant
#
Applicant: />>~ tfbtlTf~ 1Ze::,P7/.3/~~ Phone: _r:r/~c:J'.s-.s-r
Address: 2t?OO ~~V S PIC?-. :1ft 10
Signature: ~ J>r-YHOi/n-f/ .$r-~~ t'
Legal De~li~n: LoU 2 / Block / Sub: t)/1c /</D6F: (y(
Site Address: ISZZ I F!ileLI"1h..IN .5/tt)R E!;' / K/J/ i..--" /ZI$ 0
Building Permit # q 9 - tp 17 PIO #..25 -0A3 - OZ.( - 0
NOTE: This permit will not be processed without complete information.
FIXTURE UNITS
Type of Fixture
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatory (bathroom sink)
Laundry Tray (1 or 2 compartment sink)
Shower Stall
Sinks:
Bar Sink
Water Closet (toilet)
Rough-ins
Water Heater
Water Softner
Stand Pipe (wasl
REQUEST FOR INSPECTION
Sewage Ejector SENT TO HOMEOWNER 1/03.
Backflow Assemt NO RESPONSE. CLOSE FILE
Backflow Assembly I a::n
Lawn Sprinkler
Other
/
Minimum Fee
Unit
Amount
$ 6.00
$ 6.00
$ 6.00
$ 6.00
$ 6.00
$ 6.00
$ 6.00
$ 6.00
$ 6.00
$ 6.00
t &.e&
$ 6.00
$ 6.00
$ 6.00
$25.00
$10.00
$25.00
$ 6.00
$25.00
SURCHARGE
GRAND TOTAL $
Total
3Cf.5D
.50
40.00
This permit is granted upon the express condition that said
contractor, shall comply in all respects with the ordinances
of the State Plumbing Code and the amendme~.lhereof.
~tJ.(P RJ9:~. ~/~ffLDATE
~L:e:-- AITEST
Call for affJ inspections 24 hours in advance.
4629 Dakota St. S.E., Prior Lake, Minnesota 55372 / Ph. (612) 447-4230 / FAX (612) 447-4245
AN EQUAL OPPORTUNITY EMPLOYER