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CITY OF PRIOR LAKE PLUMBING PERMIT S--
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I.Slut File / /
z.Gold cityPERMIT NO. ill. ` �D 6
3.Yellow Apples / f
(Please type or paint and sign.at bottom)
ADDRESS ZONING(office use)
to5t ‘. Etil\L 0 ruL .,,i,,,ii,LEGAL DESCRIPIION(office use only)
LOT 1°BLOCK 1 ADDITION & • e E t PID Q - 1
OWNER
(Name) (Phone)
vn\0 1 (Phone) )---s-1 3 40
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(Address) 1 cL il 11Gi , INf-IvA •J &Uc^ P1ki , 011
(A.a 1. s) (City) ' (Zip Code)
(Contact Person) l� l�t1 (Phone) I�Z-`a 13 *31 La
APPLICANT SIGNATURE �.1 it ' 1,..Li oi—l. 4.4. DATE to- '2015
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower _, Rough-ins
DishwasherWater Heater
Floor Drain Water Softener
Lavatory(Bathroom Sink) Stand Pipe(Washing Machine)
Laundry Tray(I or 2 compartment sink Sewage Ejector
Shower Stall Backflow Assembly
Sinks Backflow Assembly Test
Bar Sink 1 Lawn Sprinkler
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Water C1oset`(Toilet) Oilier ,., ,, y:
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
The Minnesota Statutes§326B.148 $ Building Permit#
"SURCHARGE"has been extended
until June 30,2013, ?LUMBING PERMIT FEE $ i. v
The minimum surcharge for a ;TATE SURCHARGE $ Int' (-750
"fixed fee"permit is$5.00 i'OTAL PERMIT FEE
'This Application BecomesYour Building Permit When Approved ®-,®s.',t Re vi Na. q3
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13U',q;_` By IC
24 hour notice for all Inspections(952)447-9854*fax(952)447-4245
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372