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( ...: P 14.6 Date Rec'd
I 9 CITY OF PRIOR LAKE PLUMBING PERMIT
J.'NEsoo
1. . coin city PERMIT NO. J
3. Yellow Applicant / / /� 9
(Please type or print and sign at bottom) !(
ADDRESS ZONING (office use)
1 C0049 1A \nicodr a Pirisoc 'aka
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
((Name) 1-1---- 9 52-?'-fO - 5 b
(Phone)
(Address) S�,(S r Vv 556 Its
APPLICANT
(Name) pion PWV)IcI (Phone) 1 N:J cJ ) a'1
(Address) ` / .
(Address) (C (Zip Code)
(Contact Person) �i (Phone) (( .o5' ( - O
APPLICANT SIGNATURE `' y -
__
_- - DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher J 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 § 3268.148 Est $ Building Permit #
"SURCHARGE" has been extended 1 59
until June 30, 2013, PLUMBING PERMIT FEE $ '•'�`7
The minimum surcharge for a STATE SURCHARGE $ .50
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ pl-t _ 50
This Application Becomes Your Building Permit When Approved Paid ei t N . IF eipt
Date
Building Official Date 1 , ' I i
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245 i 1 0 ' qik 4646 Dakota Street S.E., Prior Lake, Minnesota 55372 l