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Date Rec'd
��� Rto�t CITY OF PRIOR LAKE PLUMBING PERMIT
N �
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� t. Blue File
2. Oold Cny PERMIT NO . � Z� ���7
3. Yellmv A�lirm�
lease or ' t and sI at bottom
ADDRESS ZONING (ot�'i« use)
33�2 Ti�t,rn�r Dnv�
LEGAL DESCRIPTION (oB6ce use only)
LOT BLOCK ADDITION PID
OWNER 1 lil r 1'l�l (Phone) �� �`i - 035�-
(Name) ,
{aa.are�) 3 � r �
APPLICANT
�� (Phone)
pp ance installers of MN, Inc.
(Address) �Clt�,� (Zip Code}
Prior La c�, 55372 .
(Contact Person) 'C�_�C-SnP ��� ��(�1(�.r'}'1n {Phone) -
APPLICANT SIGNATURE DATE �
APPLICANT PLEASE COMPLETE BELOW
uanti T e of Ftixture uanti e of Fixture
Bath Tlxb wi#h or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain / Water Softener
Lavato afhroom Sink Stand Pi e ashin Machine
Laun Tra 1 ac 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink La�vn S rinkler
Water Closet Toilet Other
F'EE SCHEDULE
Industrial, Commcrcial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One &'ItvaFamily $149.Sa
Residential, Additions & Alterations $49.50
The Minnesota Statutes $ 326B.148 ��st $ Buiidin� Permit #
"SURCHARGE" Ei�,s been changed for one pLUMBTNG PERMIT FEE $ S7. �
year effective
.1:31y ➢, 20Y0 antii ,7une 30 zOt 7. STATE SURCHA.RGE $ 50
The minimum sorcharge for a "tixtd fee" permit TOTAL FERMIT FEE $ 7`7►. J�
is'5�.4, beginoing July (, 2010
This Application Becomes Your Bu�7ding Permit When Appcoved Paid �/ ��-� Recei o. I_ t—1 _��
7- U! J iU
Date� . /3 / Z- B
Bailding Oftidal Date `
24 hour noHce for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dskota Street S.E., Prior Lake, Minnesota 55372