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CITY OF PRIOR LAKE PLUMBING PERMIT
U
�rESO'�
`. 8N " �'` PERMIT NO. / ?
2 Odd Cpy
3. YNbw Applaaq .J
C 0� � it bOLtpffi
ADDRESS ZONING co�ce �se)
l S�-o 8 �e� C�x ks �oaa( 5.�.
LEGAL DESCSIPTION (o�6oe �e oniy}
LOT BL�CK ADDITION PID
OVIrNER I ,�
(Name) � w � (Phone) �'u�a ' o��o — o� l�
t�) U 5 �.,
, �,
c��;`� ; ; �c �n �, asa-8�s-3�3
(Aaare�) � C' � o S 6
(Address) (Cicy (Zip Code}
(Coatacx Pe�on) ` �i I�O' {phone) SQrn e- '
APPLICANT SIGNATURE DATE a l�
AP LI ANT PLEASE COMPLETE BELOW
uaeti of Fixtare anti �f FL�rtare
Bath 'IY�b witi� or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Wat�er Softene�
La.vato athmom Sink Stand Pi ashi Machine
Laun Tra 1 ar 2 cv t sink Sewa E'ectar
Shawer Stall Bacl�low Assembl
Sinks Backflow Assemb Test
Baz Sink Lawn S' ex
Water Closet oilet pther
FEE SCHEDULE
Induatrial, Commtrcisi & Multi-femily I°� o�job coat with a$49.50 minimum Residentiel, New One & Two-Family $l49.50
Residentiat, Additions & Alterations 5�19.50
Thc Minnesota Statutes � 326B.i4tt ���st $ Building Permit # �
"SURCHARG�" has been changed for one
y�ar effective PLUMBING PERMIT FEE $ �-�'� r
,Iuty �, 2010. untit .�nne 3t1, z0► �. STATE SURCHA.RGE $ .�: Q>>,�6�
The minlmum snr�cparge for n "tixed fee" permit TOTAI. PERMiT FEE a � S'�-�,_�
is �i, begfnning 3uly 1. 2010
Thls AppHcadon Becomes Yoar Buildlag Permit R+h� Appc�ved Paid Y r71 R ipt N. � I O
7V
s.u�re oetat�� na� � ��%� ,� � B
24 6oar notice for all inapectioxs (952) 447-9850; f:z (952) 447-4245
46�6 Dakata Street 3.F�, Prlor Lake, Mlnae�ota SS372