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CITY OF PRIOR LAKE PLUMBING PERMIT Date Recd
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lease /. or , • t and si_a. at bottom 7. Yellow Applicant
ADDRESS
` / ZONING(office use)
I .0 g
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWNER
(Name) ►�( N. S N I
(Phone)
(Address) A
JA •
APPLICANT
(Name) , . Connections Inc.
(Address) 12854.Chestnut BIy•. (Phone)
(Address)
952-445-4803 (City) (Zip Code)
(Contact Person)
(Phone)
APPLICANT SIGNATURE
---!—��,1.'eLdok � DATE 3 1 g ( �
APPLICANT PLEASE COMPLETE BELOW
T t e of Fixture ■
Bath Tub with or without shower T t e of Fixture
Dishwasher �� Rou:h-ins
Floor Drain ��ib� Water Heater
Lavato Bathroom Sink 1111111111111
Water Softener
Laun. Tra 1 or 2 com.artment sink Stand ePWashin: Machine Shower Stall _� Sewa: E'ector
Backflow Assembl
Bar Sink Backflow Assembl Test
Water Closet Toilet Lawn S.rinkler
Other
FIndustrial,Commercial&Multi family 1%of job cost with a$EE mE inimum
mULE
Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
The Minnesota Statutes§326B.148 Building Permit#
"SURCHARGE"has been extended
The minimum surcharge for a UMBING PERMIT FEE $
"fixed fee"permit is$5,QQ 'ATE SURCHARGE $ .50
3TAL PERMIT FEE $ •
This Application Becomes Your Building Permit When Approved Paid A
��S—jJ Rece" o.
Balldins Official Date ., 3— B 211.1.111111
41
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372