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CITY OF PRIOR LAKE PLUMBING PERM
. a. m e 0
v JUL 0 2 2009
33 . oele car d 1 NO. t o in"
. Yellow Want ....e.,.:__,/ -
(Please type or prlrt said sign at bottom)
ADD si - q y C • S ZONING
LEGAL DESCRIPTION (office use ooly) •
LOT BLOCK ADDITION PID
OWNER (N C� 4'204:9i�/2r__, (Phone) -
( ) S5 �' 7---,-,,,,z_ &-
: / / / �/' •
(Name) / TGL Air Are (Pone) � Y ,37:79k (Address) -- 2 % a ✓ 1.--e Q/' ( '-- 1.
(Address) /� (City) (Zip Code)
(Contact Person) 1 2 V'C/ /!-7 (Phone) £ 1 2 2
APPLICANT SIGNATURE v /_ " // .l. - �� iv. ii TB eP e e /
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quash' 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 (I or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink l Lawn Sprinkler
Water Closet (Toilet) Other
FEE SCHEDULE
Industrial, Commercial & Multi- family 1% of job cost with a 549.50 minimum Residential, New One & Two - Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ ¥OD - — Building Permit #
PLUMBING PERMIT FEE $ Vv. sZ ,
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ _ --
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid , tZ Recei No. 3/ lA
Dn ldiai Official Date Date 7 1 . a l B •
l
24 hour notice for all inspections (952) 447-9550, fax (952) 447 -4245
4646 Dakota Street &L, Prior Lake, Minnesota 55372