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CTTY OF PRIOR LAKE PLUMBING PERNIIT
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LOT BLpCK ADDITION PID
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APPLICANT SICiNA DATS
APPLICANT PLEASE COMPLETE BELOW
nanti of l�ture uanti of Fi=tnre
Bath '15�b with rn without shower Rou -ins
Dishwaeher • Water Heatex '
Floor Draia Watea Softcner
Lavato Sink Stand ' ashi Machine
La TYa 1 oc 2 ar�t sink Sewa B'ector
Shower Stall Backtlow Assembl
Sinks Backflow Aasemb Test
Bar Sink l.awn ' �
Water Closet oilet ' Other
FELSCHEDULE •
I�ustriat, Commercial8c Mulfl-family IYo of job cost with a 549.50 minimnm Residentlsl, New One & 1tvo-Family SI49S0
Rasidaotial, Additlons & AlOeaatio� 549.50
7Le Minnesota Statuus § 326B.148 ..�� s Buiidin8 Parait #
"SURCHARGE" has ban d�anged for one
ycar etPective PLIJMBING PERMIT FEE � •.
July i ..2oto. ant3l.ivae so, ao� l. STATE �URCHARGE a.
The midmum mMa�e for, "llred tae" Permk TOTAI. PERMIT FEE a
i� begi�iag-Jnly 1. 2010
This AppUcatiou Becomes Yoar BnDdinY Pern�it When Approved Paid �.� Recei�t,N
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