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CITY OF PRIOR LAKE PLUMBING PERMIT
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���� �. e��e File PERMIT ND �Z ,��.
2. cow c�ry •
3. Yeliow Applicant
18 � t 811/� 8 8Y {MLtOnt
DRESS ZONING (ot�e �>
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LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
(Name) ' s2 � Q�f' (Phone) �v'� Z - �14Kc - �p'L�
(Address) � � (9 � �/' � , �.cZ
APP T _
am �,.�.. C., (Phone) 2 _�Z5�3 .�� �
ddress) _ � f�^ t= ,,� .�S
(Address) (City) (Zip Code}
ntact Per ��.,t.�. �L.�Le� (Phone) �(a3 - 25$ '2�/�
CANT SIGNA ATE 1 'Z--
APPLICANT PLEASE C�MPLETE BELOW
uanti T e of Fixture uanti T e of Fizture
Bath Tub with or without shower Rou h-ins
Dishwasher Water Heater
Floor Drain Water Softener
Lavato athroom Sink Stand Pi e ashin Machine
Laun Tra l or 2 com artnnent sink Sewa e E'ector
Shower Stall Backflow Assembl
!��✓� Sinks Backflow Assembl Test
Bar Sink Lawn S rinkler
Water Closet Toilet Other
FEE SCHEDULE
Industrial, Commercial 8c Multi-family 1% of job cost with a$49.50 minimum Residential, New One & Two-Family $149.50
Residential, Addirions & Alterations $49.50
Estimated Cost $ Building Permit #
The Minnesota Statutes § 326B.148 pLUMBING PERMIT FEE $ ��� �
"SURCHARGE" has been extended STATE SURCHARGE $ _� .,�u.�' 8�
unril June 30, 2013, TOTAL PERMIT FEE $ .S , fv
The minimum surcharge for a
"fixed fee" permit is $5.00
_ ,ding Permit When Approved Paid S v R i No.J_ ���
__—_ _ CD
sond�ne omcia� nxte Date �. " viY • f L- B
24 hour notice for all inspections (952) 44T-9850, fag (952) 447-4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372
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