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APR i91 R `
CITY OF PRIOR LAKE PLUMBING PERM •
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I. Blue File PERMIT NO. �(/� y 1
2. Gold City , /� 1
3. Yellow Applicant VV
(1`-"R, L-�--
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
X 67963- C;t`eetsih ( rde- SE
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) ho0-Zr1 SC -h 4 (Phone) o 0- 0— p0
q 7
(Address) /6079 3- ateei 'G re € J€
APPLICANT ,/� p
(Name) S V OTY1b(lS 1 Ner SA.c64--IT� (Phone) !�t9-(J 111 C
(Address) 72c/ �,O1 `11- I '1 S ftp 3�
(Address (City) (Zip Code)
(Contact Person) ; C�KI % `N{'(�Ck. (Phone) gSr-D 1�&�/r at a
APPLICANT SIGNATURE AIP dh&& - /�° 4. DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher t _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
FEE SCHEDULE
Industrial,Commercial&Multi-family 1%of job cost with a$54.50 minimum Residential,New One&Two-Family $154.50
Residential,Additions&Alterations $54.50
Estimated Cost $ 5741S-0 Building Permit#
PLUMBING PERMIT FEE $ St/.
STATE SURCHARGE $ 1.00
TOTAL PERMIT FEE $ 5J,SO
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Receipt No. .?4/I]
Date \ ri.1 I
By
Building Official Date
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372
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CITY OF PRIOR LAKE PLUMBING PE ' I N APR 1 9����R.'
J l • By
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2.Gol
1.Blued FileCity PERMIT NO. 0v )3 _.-046.2_
3.Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING(office use)
I&71s C,e_e.r.sictz ' ` rcJe SE-
LEGAL DESCRIPTION(office use only)
LOT BLOCK ADDITION PID
OWNER pp
(Name) t`er) SChtr..)rtrcz- (Phone) C2/?— 810- gO cl 7
(Address) l6979S- tom' i i A_ ureic SE,
APPLIC �® �j
(Name) �J ?ulbin.�fYI 1-leck- uky- ,/� (Phone) l S —(0 'al- t c
(Address) 74257 UOCA.S6l1%ken Aut S F e . Sj 3
(Address (City) (Zip Code)
(Contact Person) c tkf 11 ' i•Veof -k. (Phone) Q's'?-6 81 - at t Ss
I
APPLICANT SIGNATURE Alli A r(. DATE /Mail
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough-ins
Dishwasher 1 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
FEE SCHEDULE
Industrial,Commercial&Multi-family 1%of job cost with a$54.50 minimum Residential,New One&Two-Family $154.50
Residential,Additions&Alterations $54.50
Estimated Cost $SY.ST) Building Permit#
PLUMBING PERMIT FEE $ s
STATE SURCHARGE $ 1.00
TOTAL PERMIT FEE $ SSI SO
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paidti� Receipt No. ?/f/
i_j_
Date t1 td By
Buildine Official Date o
24 hour notice for all inspections(952)447-9850
4646 Dakota Street S.E.,Prior Lake,Minnesota 55372