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Data Recd(5)
CITY OF PRIOR LAKE PLUMBING PERMIT
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City PERMIT NO. .-_-:":441—P--7
3.Yellow Applicant L._,
(Please type or print and sign at bottom)
ADDRESS ZONING office use)
t064 •gary'
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) evvvseik "-yN, 74rittiej
(Phone)
(Address)
PPLI)ANTAI_col&n
(Name) (Phone) �(p l2,'Q Gr41,:gr'
J� �
(Address) 3--1 7 Z� I.t.Q�L�� / 1�(rk/ m� )-e'
(Address) (City) (Zip Code)
(Contact Person) �� (Phone) 6 )-Wee*1947
APPLICANT SIGNATURE ' ' DATE 11
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity 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(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
Estimated Cost $ 7 t`D Building Permit# Illt 1ellilIlesu<a)LdLutea y JavD.l`ru
"SURCHARGE"has been extended
PLUMBING PERMIT FEE $ The minimum surcharge for a
STATE SURCHARGE $ "fixed fee"permit is $5.00
TOTAL PERMIT FEE $ ,- 1
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid 61 Receipt No.11
Date „oy By ��
Baildine Official Date j�j
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372