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CITY OF PRIOR LAKE PLUMBING PERMIT
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' �. a "` "'` PERMIT NO. � '�
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or md atLottamo
ADDRPSS � ZANINGI (ot�ice me)
5�3 . '1f IGl � U �� ��. �
LEGAL DESCRIPTIOYd (oe6oe use only) .
LOT BLOCK ADDITION PID
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APPLICANT SIGNA ' DATE t,Ji � � ���
APPLICANT PLEASE COMPLETE BELOW
uan of FSiture anti of Firiare
Bath 1�b with of without sh�ower ins
Dishwasher � Water Aeatar
Floor Thsin Water Softeaer
Lavato m Sink Stand ' ashi Machine
La Tra i or 2 t sink Sewa E'ector
Shower Stall Backtlow Assembl
Sinks Bacicflow Assemb Test
Bar Sink Lawn ' ea
Water Ctoset oilet ' Other .
FEL SCf�EDULE •
laiustrial, Commercial & Multi-family IYo of job c�t wnd� a 549.50 miom�um Resi�ntial, Ncw One &'l�vo-Family S I49.50
Residmtiat. Addttious dc NGaaHone 549.50
71►e A4innesota Statutes g 326B.148 ..�� S o�v" " w Building Peimit #
"SURCHARGE" has beai changed for one
yareflFective PLUMBING PERMFf FEE $ S�. U
Jutyi ..sota��uad�a�o,�oi�. STATESURG�iARGB S. •
'me mietmuu :arcluirge ro.. "ttrcd r«" pe�t TOTAL PERMIT FEE S��
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T61s Appdcation Becom� Y'oar Ba�]1ng Perinit Whsn Ap�rov�d Paid � w r-J� Receipt No. ��
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• 24 hoar aotla fer all iot�eet (952) 447 98504 fiz (�952)147-4345 ,
4646'Dakoti Stroet 3$ Prlor Lake, Mi�rie�o4 53372 -
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