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Don /Edith Schrope
(.(i
R 5416 Manor Road Date Rec'd
f' Prior Lake, MN 55372 L,UMBING PERMIT
9524473501
M /NNESD 'cP 1. Blue File A � I
2. cold city PERMIT NO. `/ 44t
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS q- / ^ ( R-O ZONING (office use)
glad
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) DM Ea GAL Scfl o r p-eJ (Phone) ( SZ) 414 • L-35 I
(Address) El-Fite V J( O , R O Q4
APPLICANT J � ( 19 P rvlk I v L q / / n f Z) Q 't 1 , '1033 3 3
(Name) (Phone) I C/ C l Y u l
(Address) 2 q 0 5 ft d, ad -. l V & 15 (%-/c8
(Address) (City) (Zip Code)
l 0 1 Z) g- '7 - '-fX33
(Contact Person) (Phone) / /
APPLICANT SIGNATURE /' ' DATE 5 / �/ I/
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi- family 1% of job cost with a $49.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
rst $ uW .w Building Permit #
The Minnesota Statutes § 32613.148
"SURCHARGE" has been changed for one 5d
year effective PLUMBING PERMIT FEE $ 4./
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ ` .5 0a
V
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ lJ
is 55, beginning July 1.2010
This Application Becomes Your Building Permit When Approved Paid S _ * Rec • t No./ Z /
Date // l(J /
Building Official Date (Q •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372