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P RIG Date Rec'd
CITY OF PRIOR LAKE PLUMBING PERMIT
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I. Gold File P ERMIT NO. _2_
7.3
2. Gold city l
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
L/1-i P'iOr\NWct. cif
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER ��Cj, A 1 1 1 ( Gold WT` � (Phone)
(Address) 1 4-i Prior wood St
APPLICANT Appliance Connections Inc.
(Name) (Phone )
12850 Chestnut Blvd.
(Address) Shakopee, MN 55379
V9113/N445-4803 (City) (Zip Code)
(Contact Person) 3U4 R Pe] (Phone)
APPLICANT SIGNATURE 6u7414 PCP1 DATE
Y - 13
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher 1 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
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The Minnesota Statutes § 326B.148 $0` Building Permit #
"SURCHARGE" has been extended
until June 30, 2013, 'LUMBING PERMIT FEE $
The minimum surcharge for a ;TATE SURCHARGE $ .50
"fixed fee" permit is $5.00 TOTAL PERMIT FEE $ 4 c j fi 6-4)0 ZI
This Application Becomes Your Building Permit When Approved Paid v Receipt No. 4 r/
Date , ` /Q/ By p..„,.& Building Official Date `7
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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