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01 PR/04 • . - - Date Rec'd
i(i:C41!k CITY OF PRIOR LAKE PLUMBING PERMIT
—
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`4<flivinsdo* . ...
PERMIT NO. 57 i 3 ss7,
-. .Yellow Applicant
(Please type or print and sign atbo(tom)
ADDRESS -.
55 37 ON - ZONING(office use)
Lf-t?930 Cordy eoLce---rd -0- .q Ris_4
.,„ .
LEda.DESCRIPTION(office use only)
-;-•,,,c1-4&04- 4,42-•it&s,f.11& RAW- --7-17---c__ • 6 I 7.---
LO.1. ADDMON PDD 25-
- „
• _
I
(Name) . 1)),(2,4/40 -Dektvedac - --- (phone)95 4-7 6423
(Address) .1- 30 MI-
APPLICANT ,
(Name) Appliance COMI0C601111 111C(Phone) .
12850 Chestnut Blvd.
(Address) Shakopee, MN 55379
(Address) 952-4451.4803 (City) (Zip Code)
(Contact Person) 4 e 0..i 0 0 0..._ I (Phone)
-,
APPLICANT SIGNATURE" qt. / ' I SW! - DATE 6 241 AS
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
i . .
FEE SCHEDULE . -
Industrial,Commercial&Multi-family 1%of job cosi with a$45.50 minimum Residential,Ndw One&Two-Family $149.50
Residential,Additions&Alterations $49.50. If,
:-.
The Minnesota Statutes§326B.148 $ Building Permit# :,
"SURCHARGE"has been extended '5° -
The minimum surcharge for a -. PLUMBING PERMIT FEE $
'77"fixed fee"permitig$5-.13$' ..STATE SURCHARGE $ L div -TT
TOTAL PERMIT FEE $
This Application Becomes Your Building Permit When Approved Paid - ...s.,0 Receipt No.-3 2?
• Date By
BuildeO -.
Date I1 .4. f c C. .•
...,
'' -" -• - .'- 24 limit notice for all inspections(952)447-9850,fax(952)447-4245
. s ----" ''' -- -4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
-.. ..