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1 PRI0 • .
. - • . ' Date Rec'd
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F.r Is CITY OF PRIOR LAKE PLUMBING PERMIT -_ --
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Gti Fcty PERMIT NO. / 13 fig/
.._ •• 3.Yellow ANdicsat
(Please type or taint and sign atiooltom)
ADDRESS- - ZONING(office use)
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1 17-CO rO n
1 .v. _S e idi, CJ L„.., ..
LE41.DESCRIPTION.(Oirtee use only)
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LOT D BLOCK .?>ADDITION .: )(L" ...-i;Z;-..Tr ..0 — frimIAO N. PrD(275- 3q , a9-e,
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OWNER
(Name) N. GI 4 AIPA_pet Ike, &5117O (\ - -:' (Phone)
(Address) 501/n/LL/
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APPLICANT . .
(Name) APPhance ConnectOrli Irm(Ptone) .
11850 Chestnut Blvd.
(Address) sihs00pee, PAN 553 79 •
(Address) 952-4454803 (City) (Zip Code)
(Contact Person) •Jt/rYll 1, "...1 (Phone) -
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, .. DATE
APPLICANT SIGNATURE. .
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''''' •. . /APPLICANT PLEASE COMPLETE BELOW
Quantity • Type of Fixture Quantity " Type of Fixture ,
•. Bath Tub with or without shower Rough-ins
Dishwasher f 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
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Water Closet(Toilet) _ Other "
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FEE SCHEDULE .'
Industrial,Commercial&Multi-family 1%ofjob cost with a$45.50 minimum Residential,Nw One&Two-Family $149.50
Residential,Additions&Alterations $49.50. V
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The Minnesota Statutes§326B.148 ' $ Building Permit#
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'SURCHARGE"has been extended . %
The minimum surcharge for a .. PLUMBNG PERMIT FEE $ 1711 4* -°' '
STAIE SURCHARGE $ •. I
"fixed fee permit:I1457W . • ..TotAL pERmiT FEE S
50• 50
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This Application Becomes Your*ding Permit When Approved Paid 59. s-0 Receipt No.336
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• -Buntline OW*.::-..-...'...• • Date Date By
foi is— 3 -
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- ,, ,,, ..,., - • - . 7,4*i..notice for all inspections(952)447-9850,fax(952)447-4245
• .. • -.77 ' ' 7i1--.. ,-,... 4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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