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P KIp Date Rec'd
PLUMBING PERMIT ID .. � ' Michael Pulju
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5497 Cedarwood Street
INNESOC � Prior Lake, MN 55372
6122034392 z: cola File PERMIT NO. / /n
3. Yellow Applicant / O �J/ ��✓
(Please type or print and sign
ADDRESS 6 461 ZONING (office use)
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER '
(Name) 1 alita, Pit 01 (Phone) 6 W
(Address) 5i-tql CedOxvvood '
APPLICANT
(Name) . IIF . . , . 0 :. Phone) lip
(Address) (612) 827 -4033
(Addres GARFIELD AVE. SO. (City) (Zip Code)
(Contact Person) MINNEAPOLIS, MN 55408(Phone) /
/ APPLICANT SIGNATU DATE / l8 / 0
APPLICANT PLEASE COMPLETE BELOW CC
Quantit Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher ( Water Heater
Floor Drain Water Softener
Lavatory (Bathroom Sink) Stand Pipe (Washing Machine)
Laundry Tray (1 or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink Lawn Sprinkler
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
Liq Estimated Cost $ Building Permit #
PLUMBING PERMIT FEE $ Lig ‘c=
STATE SURCHARGE $ X 500
TOTAL PERMIT FEE $ `,
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 54.0 ceipt No. V t v
Date (0 •`V.1 y JY/
Buildine Official Date
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372