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� � PRip�� Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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'. B'°` F"e pERMIT NO. � �../ (/��
z. Gom c�ry 2.- /
3. Yellow Applicant
lease e or t and si at bottom
ADDRESS ZONING (otl�ce use)
1� �1 I� 5 C:� eXr C. wr-�- �5 3 �
LEGAL DESCRiPTION (office use only)
LOT BLOCK ADDITION PID
�WmTER "�V.S� � v� �U�{ CX Gt'c� (Phone) 9'.s o� -� SS - q 3 13
(Address)
APPLICANT ��-�IG�1N WATER COMDITIONING
(Name) 6030 C U LLI c;q� �,�Y (Phone)
MINNETONKA, NiN 55345
(Address) �
� ` ( ddress) " � (City) (Zip Code)
(Contact Perso�iJ �. . (Phone)
APPLICANT SIGNATURE � DATE � �—�' � o�
APPLICANT PLEASE COMPLETE BELOW
Quanti T e of Fixture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain � Water Softener
Lavato Bathroom Sink Stand Pi e Washin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'ector
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEE SCHEDULE
Industrial, Commercial & Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
� n4:.+.�.4._a �OSI i{1 a�v9�1, (�U Building Perxnit #
The Minnesota Statutes § 326B.148
" SURCHARGE " has been extended PLUMBING PERMIT FEE $ y 9�SO
until june 30, 2013, STATE SURCHARGE $ S 00 —:�@'
'' The minimum surcharge for a TOTAL PERMIT FEE $ �4 , Sl�
"fixed fee" permit is $5.00
i nis Application �ecomes Your Building Permit When Approved Paid ,/ Receipt No. , •
�7- �
Buildine Ofticial Date Date ��� 9 � y By
24 hour notice for all inspections (952) 447-9850, fag (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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