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CITY OF PRIOR LAKE PLUMBING PERMIT Date Recd
v
1. old File I PERMIT NO. /
2.Gold City /�/� I
(Please type or print and sign at bottom) 7. Yellow Applicant f/
ADDRESS
16 Cli
m I ra ( ( 5 ZONING(office use)
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION
PID
OWZR pani5e, Mo rn t
(Phone)%3 T�a 37elq
(Address) 667 11(t7e1Ti S E
APPLICANT Tony OnUC vp i Q (Phone) qS
(Address) 5 üq0 17a41% Nrnovi
(Addre� ( !� �` �!�,j7
(City) (Zip Code)
(Contact Person) (Y-,/ (Phone) qe.)-3 -Li35-
APPLICANT SIGNATURE / /./ A ..1 DATE 157(T
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixtureuanti
Bath Tub with or without shower Q Type of Fixture
Dishwasher Rough-ins
Floor Drain ( Water Heater
Water Softener
Lavatory(Bathroom Sink)
Stand
Laundry Tray(1 or 2 compartment sink E (Washing Machine)
Shower Stall Seewawagea Ejector
Sinks Backflow Assembly
Bar Sink Backflow Assembly Test
Water Closet(Toilet) Lawn Sprinkler
Other
FEE
Industrial,Commercial&Multi-family 1%of job cost with$49.50 minimum Residential,New One&Two-Family $149.50
Residential,Additions&Alterations $49.50
The Minnesota Statutes§326B.148
"SURCHARGE"has been extended Building Permit#
The minimum surcharge for a LUMBING PERMIT FEE $ 14C( , 50
"fixed fee"permit is$5.00 TATE SURCHARGE $
OTAL PERMIT FEE $ SL-1•50
This Application Becomes Your Building Permit When Approved Paid 6 U
ceipt No. + 74
Badding Official Date 4., i r( y I
Date 1
•
24 hour notice for all inspections(952)447-9850,fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372