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� 4 YRIp� Date Rec'd'
CTTY OF PRIOR LAKE PLUMBING PERMIT
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� i � �. PERMIT NO. �
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LOT BLOCK ADDTiTON PID
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APPLICANT SIGNATURE � DATS �" I I
APPLICANT PLEASE COMPLETE BELOW
aanti of Fistare anti of Ffatnre
Bath 11�b with o� without shpwer ins
Dishwasher � Water Heat� �
Floor Disin Wates Softeacr
La Sink Stand ' sshi Machine
La Tra 1 or 2 o- t sink Sewa B'ector
Shower Stall BackAow Assembl
Sinks Backflow Assemb Test
� Bar Sinlc Lawn ' ea
water Cioset oilet ' Othor .
FLE SCHEDULE •
lndustriai, Commercial & Mula-family IYo of job c�at witl� a 549.50 min�am Residan6al, N�vv One & Two-Fanoily S 149.50
Residentisl, Additions dc Atteratlons 549.50
71►e Minnesota Statuces $ 326B.148 ..�� s� DG .� Buildin8 P�mit #
"SURCHARGE" has bern chenged For o�u �
ycar effective PLLTMBING PERMIT FEE a
���y �..aoto. n,�t� ad�� so, zoi �. STA'TE SURCHARGE $._ �
7Ue misGoua �artYarge for a"fucd t«" Per�it TOTAI. PFRMIT FEE S
�,�5 dq'J��B i. Sm9 .
T61s Appdcatlou Becomos X'oar Bailding Peradt W6en Approved Paid �—,� / s� Receip o. r�-7� �,
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B�Id�[ O�LI �te ��te J�—.. f Cj � f��i BY
. 24 6oar aotla fer all i�e�u (952) 447�lSS0. tu �52)1�7-4245
46,16'Dnkola 3trcet 3.E, Pdor L�ke. Mlariaa�a SS372 .
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