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N 4P CITY OF PRIOR LAKE PLUMBING PERMIT
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Blue File
2 Gold City PERMIT NO.` z c')
(Please type or print and sign at bottom) 3 Yellow Applicant
ADDRESS ZONING(office use)
.62 g/ fl) JR4 V) NW
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OVVNE
rpt
((Name) "t i+ rA Lei11ke . (Phone) ' S R- 4 +-0,-0,2g/0g�
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(Address)
APPLICANT
(Name) Appliance Conncctions Inc. (Phone) I
(Address) 12.850
0 Chestnut Blvd.
( ..� , ,.,, ;MN 55379
,. - .;