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a ;};e CITY OF PRIOR LAKE PLUMBING PERMIT
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I:PleI.slue File PERMIT NO.
2.cels City /b---. 08� "
d Applicant
(Please type or print and sign at bottom)
ADDRESS
LA-,
ZONING(office use)
1o5'- I II SE
LEGAL DESCRIPTION(office use only)
1,50
LOT I BLOCK I0ADDITION 40,r1 Z -.-- at& 146474cPID 25- SDO.- 410 - b
OWNE
(Name) ace 1 (Phone) °M2.-- 239--b t 3
(Address)
APPLICANT .
(Name) N1.N 'P 1 l.U11101 rn 't Ap\ 1 aLin CI ktC (Phone) %Z-Li Le 9— c3L
(Address) I41 05- 12-UL1/ St ! '�1''I'.1),,,- C.I.IL
Le_ kk) i 6J 39-Z.
(Ad kess) (City) (Zip Code)
(Contact Person) kit C. I Ie (Phone)
APPLICANT SIGNATURE . A /MI �► DATE
i
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 ti 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
The Minnesota Statutes'326.13.148 ^ist $ Building Permit#
"SURCHARGE"has been changed for one
j year effective PLUMBING PERMIT FEE $
July I,2010.until June 30,2011. STATE SURCHARGE $ .50
''. 'The minimum surcharge fora"fixed fee"permit
.,,I, is 5.iTOTAL PERMIT FEE $,beginning July 1,2010 SH ` 50
This Application Becomes Your Building Permit When Approved t P Receipt No, IP [A
D.te ` ( 'Mardi
Building Official Date t l
24 hour notice for all inspections(952)447-9850,fax(952)447-4245 /
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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