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Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT (g f
A '
`
� A PERMIT NO. Z
3
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
L- i o (1 1 1 Tref 11
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER In ` q iyy ° / /
(Name) �,1y I Q � �
1 � (Phone) I �� � "L v 1/3-6/ {Address / W D lie m S c�
APPLICANT
(Name) L / t N� s' (Phone) 1150)" O p
R S 3 L1
(Address) 5 3 Ce r L► 1 A V e i'rk.t e d ,c37.36
(Address) _D L (City (Zip Code)
(Contact Person) 1 TrY'\ L---A ACt r \ O I i'Y� (Phone) 3 Q 11\c-
APPLICANT SIGNATURE & �� • V DATE 1
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher i 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
The Minnesota Statutes § 326B.148 -.Est $ Building Permit #
"SURCHARGE" has been changed for one
year effective PLUMBING PERMIT FEE $
July 1, 2010, until June 30, 2011. STATE SURCHARGE $ .50
The minimum surcharge for a "fixed fee" permit TOTAL PERMIT FEE $ ,j if;, 5Q
is 15, beginning July 1, 2010
This Application Becomes Your Building Permit When Approved Paid `t .-v Rec 'pt No. 6 5 z 34
Date 3
Banding Official Date
24 hour notice for all inspections (952) 447-9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372