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Plumbing 07-1168
Date Rec'd CITY OF PRIOR LAKE PLUMBING PERMIT ~: ~~ ~~ I PERMIT NO. 01- "'ILa. I 3. Yellow Applicant . tx.I . (Please ADDRESS ZONING (office U9>)(l( S D 00.. \<L 'S E -\>," C{" L~~~ LEGAL DESCRIPTION (office use only) f) LOT LOCK ADDmON f<.-~ 0 A~ pm -z:; -0 +7. -oz-) d OWNER (Name) J -0 .~~"" \\ -e 0-. ~ -e { ~--e cl t' rC C~ (phone) (Address) . .~, {te~ S"E LCL k-e APPLICANT \ \ (Name)=(<',~~:\.c-r\ S ~u.<;.-.\.o." ~~"\-~ r (gi~\ E)(~e\ S~o( B\v~. ~;lDIo (Address) (Address) (Phone) S-\.. L cu.~~ (City) <1Sd- q ~()--Jg()() ~~f r N\1J 5Si,(P , (Zip Code) Quantit (phone) (Contact Person) APPUCANT SIGNA 11JRE DAlE T PLEASE COMPLETE BELOW Quanti PI "/07 e of Fixture FEE SCHEDULE Industrial, Commercial & Multi-family 1% of job cost with a $39.50 minimum Residential, New One & Two-Family $99.50 Residential, Additions & Altemtions $39.50 Estimated Cost $ ~20 ~ Building Pennit # ,PLUMBING PERMIT FEE $ STATE SURCHARGE $ OTALPERNUTFEE $ 3q 50 .50 i.f('j o,,;;!. This Ap Paid Receipt No. ., ~ o'l. ~ By (ft- 2 notice for aU inspections (952) 447-9850, fn (952) 447-4245 uoseD~OOEiil~;;;'i;;;2_1~ 07. O'Z7