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CITY UF PRIOR LAKE PLUMBING PERMIT ����
U
� . L 81� File P�I lllfll' 1 i\�. / 7 ."� �j�
2. Oold Chy � 4. l�..,�
� 3. Yellow Applicnnl
ease or and si at bottom
ADDRESS ZQNING t�a �)
�, ��cv►u,'� ,� S �'
LEGAL DESCRIPTION (o�ice use only)
LOT BLOCK ADDITION PID
�� �;��� � e � v��� ��orie, ��3`� �/�0� � ��
cAaaa�ss� c� �
AI.'PLICANT
(Name) �Q.1/Y),`�'G__ {Phone)
(Address)
(Addxess) {City? (Zip Code)
(Contact Person) (Phone)
APPLICANT SIGNATURL� � DATE � �
APPLICANT PLEASE COMPLETE BELO'V�
aanN T of Fti�are antit of Ffxtttre
Bath �b with or without shower Rou h-ins
I?ishwasher Water Heater
�loor Draiif Water Softener
Lavato athroom Sink Stand Pi ashin Machi.ne
Laun Tra 1 or 2 com artment sink Sewa e E'e�tor
Shower Stali Backflow Assembl
Sinks Backflow Assembi Test
Bar Sink Lawn S rinkler
Water Ctoset Toilet Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job c�st with a$49.SU minimum Residential, New One & TwaFamily $149.50
Residential, Additions & Alteratio� $49.50
"Che Minnesota Sta#e�tes § 326B.14R .� tst $ Rtuldin� Permit #
"StIRCHf1RG�" lias been changed for one
year effective PLLJMAING PERMIT FEE $ �
.Iui,y i, 20t0 �ntii Jene 3fl z01 i. STATE SLTRCHA.RGE $ .50
The mintmum st�rcbarge for e"fixed fee" prrmit TOTAL PERNIIT FEE s
is ^�i, begin�ing Juty l, 20]0
Thla Application Becomes Yoar Building Permit Wl�en Approved Paid � �—O Recei o. ��--� G
7 U
BalldLiII Official Date Dat yf_ r � . /�
y -
24 hour notice for $Ii inagectious (952) 447A$5U, faa (952) 447-4245
4646 Dakata 5treet S.E., Prior Lake, Minnes+►ta 5537'2