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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
I. Blue File
2. Gold City
3. Yellow Applicant
I PERMIT NO. og . c9#~
I
ZONING (office use)
ADDRES~~; ~i ;'''"tt~lLC~t1frrc
'-\ ft L
LEGAL DESCRIPTION (office use only)
LOT
BLOCK
ADDITION
PID
OWNER C 10 -
(Name) . LJ'\ €'
(Address) 4c:i11
(Phone0~ L[ q-l'?iOcJj
JL l-l S5
APPLICANT SIGNATURE
(Phone)
/C
DATE
~
Quanti
AP LICANT PLEASE COMPLETE BELOW
T e of Fixture Quanti
Bath Tub with or without shower
Dishwasher
Floor Drain
Lavatorv (Bathroom Sink
Laund Tra (1 or 2 com artment sink
Shower Stall
Sinks
Bar Sink
Water Closet
e of Fixture
FEE SCHEDULE
Industrial, Commercial & Multi-family I % of job cost with a $49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $
Building Permit #
PLUMBING PERMIT FEE
ST A TE SURCHARGE
TOTAL PERMIT FEE
$ 4~ 'SD
$ .50
$ CSD C\t:)
(Office Use Only)
Buildin!! Official
Date
Paid /:./ '. (" ,-\
_X/.'I.../
Date I
If .I
'No. ;/C7 (1
_,) II /
This Application Becomes Your Building Permit When Approved
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372