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Date Rec'd
04 pR-1°4, CITY OF PRIOR LAKE PLUMBING PERMIT S '—../N
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411N1VBS0S 2.
1.2.cola !licant
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ZONING(office use)
•lease j. or • t and si at bottom ��
ADDRESS // ..5.77.7. • �
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LEGAL DESCRIPTION(office use only) /l_i
BLOCK � 4� PID J';`' ^io
LOT Z / ADDITION �� -S
OWNER
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(Phone) 71 �,-
(Name) �- k_ /�
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(Address) f
APPLICANTn tr a i r e 1 (Phone)
(Name) r[fAfi[�i{a a[R r nNr�[Tinr ir,r r.
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7402 Washing ton Avenue (Zip Code)
(Address) (A �5rairie2-941-1044, MN 55344 (City)
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Sc LL G /II (Phone) - .C.-4-
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(Contact Person)
APPLICANT SIGNATURE
BrirAir DATE
APPLICANT PLEASEC �L, BELOW T�,a of Fixture
Quanti T��a of Fixture
_ Roush-ins
III_— Bath Tub with or without shower �.
—� Dishwasher Water Softener
_. Floor DrainIIIII . Stand P Pi.e Washin: Machine
111111111111111111
Lavato Bathroom Sink S and E'ector
INIIINIINIIII
Laun e Tra 1 or 2 corn•artment sink IIININIIIIII__ Backflow Assembl
Shower Stall Backflow Assembl Test
MIIIII Bar Sink 111111111111111 _- Other
Water Closet Toilet
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
Estimated Cost $ J 2c Building Permit#
PLUMBING PERMIT FEE $ ---✓�"
STATE SURCHARGE $
TOTAL PERMIT FEE $ -S ' SS
(Office Use Only) R / , Receipt N J'��
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This Application Becomes Your Building Permit When Approved NV; t�qr,
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API
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