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0 � pRjO� Date Rec'd
,� CITY OF PRIOR LAKE PLUMBING PERNIIT
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3. Yelbw Appliaa�
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LEGAL DESCRIPTION (offioe,ue onty)
LOT BLOCK ADDITION pID
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(Phone)
(Address) �� � Ip � '��. I M'� N �' �J� N �
� PLICANT ��� ��� �. �; i C� � � one
axne (p� � q �j � � – �Q / �
(Address) � � � � � � �` � � � -c,°�c.J T �� �J' � � (o � � /
(Address) (City) (Zip Code)
(Contact Person) � V` i �+'.� �:�4 (Phone) ���--�� c� t�� _/�
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APPLICANT SIGNATURE �� DATE _1 �Go ��
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APPLICANT PLEASE COMPLETE BELOW
asti T of Fixtxre uauN ef F'uchtrt
Bath '1�6 widi or without shower Rou h-in�
Dishwasher Water Heater
Floor Drain i Water SoBener 5,�'j
Lavato athroom Sink Stand Pi ashin Machine
Laun Tra 1 or 2 com artment sink Sewa e E'xtor �
Shower Stall Backflow Assembl
Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet oilet p��
FEE SCHEDULE
Industrial, Commercial & Multi-family lYa of job cost with s$49.50 minimum Residendel, New O� dc'I�vo-Family 5149.50
Rssidentiat, Additions & Alte�ations 549.50
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The Minnesota Statutes � 326B.148 � � �st $ Building Permit # � '
"SURCHARGE" has been changed for one ' 1 5�
ycar c ec iv PLIJMBING PERMIT FEE $ �7 �� �
.lui.v i, 2010. untii .Tune 30, zo[ 1. TATE SURCHA.RGE $ ��5 ��d
The mieimum s�ircharge for: "fixed fec�� permj� OTAL PERMiT FEE $ �y�� _�� '
` is,$,�, beginning July 1, 20]0
_ This pp omes Yaur Bnilding Permit When Approved __ Paid .7 �/„� ._ _ Reeeipt No __ r �
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Date / 3 J By
� Baiidlea OtHatat Date
24 hour aotice for all inapectfoea (952) 447-9850, fax (952) 447-4245
4646 Dakota Street 3.E., Prior Lake, Mlnneaota 55372