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CITY OF PRIOR LAKE ,
PLUMBING PERMIT
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Applicant: Mai Z Plb <d- Hd _ Phone:
Address: 1 CKcz lldSe,o✓ „f /lnf 6
Signature
Legal description of premises to be plumbed: Lo Block
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Address: X L7 IS oucla� ;S PL S5 3
Building Permit#
NOTE: This permit will not be processed without complete information.
Fixture Units -
Quantity
Type of Fixture
Unit
Amount.
Total
- Bath tub with or without shower
$4.00
Dishwasher
$4.00
Floor Drain
$4.00
Lavatory bathroom sink -
$4.00
Laundry Tray (tor 2com p artment sink)
$4.00
>
Shower stall
$4.00
SINKS:
Combination sink and tray
with or without disposal
.$4.00
Domestic with disposal 2 sinks with disposal
$4.00
Water closet (toilet)
All rough-ins
$2.00
TOTAL
SURCHARGE .50
GRAND TOTAL 32 s�
This permit is granted upon the express conditions that said contractor, shall comply
in all respects with the ordinances of the State Plumbing Code and the amendments '
there of. A q
4 Date
r�Et J'yre Attest'
Call for,al 24 hours in advance.
(612) 447.4230 • 4629 Dakota Street S.E. . • P.O. Box 359 0 Prior Lake, Minnesota 55372