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(6c. PR r0+l' Date Rec'd
j i '77 CITY OF PRIOR LAKE PLUMBING PERMIT
r.4'NEE 9
1. Blue File PERMIT NO. /a
2. Gold City
3. Yellow Applicant
(Please type or print and sign at bottom) ZONING (office use)
ADDRESS 00
r . 1 ;--e- 4 I e
LEGAL DESCRIPTION (office use only)
LOT BLOC ADDITION - T5 ZA ki tb l/Je(.(.) / - AMA/ PID f /4 - 06 2 - C
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acm i 6-4.-/ L- 4� 4 G (Phone) .-0 - BSI
4 4) , .., (Address) !7 5 i i i h , i \ kvt' P (O fe / G I,i'J
APPLICANT . Ceiitrairei
(Name) (Phone)
L
(Address) 7402 Washington Avenue
(Addrirstlir Pnlde, MN 55344 (City) p- (Zip Code)
941.044
(Contact Person) Le-e- -- one 6 C ^'/ 0
,fiiit d�C L'!^r' /� • • -7 6
APPLICANT SIGNATURE ! -.4 A DATE
APPLICANT PLEASE COMPLETE BELOW
Quantity , Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher j 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 $49.50 minimum Residential, New One & Two-Family $149.50
Residential, Additions & Alterations $49.50
Estimated Cost $ J 4 10 0 Building Permit #
PLUMBING PERMIT FEE $ L i 9' 5—c
STATE SURCHARGE $ S • -
TOTAL PERMIT FEE $ ..5
(Office Use Oniy)
This Application Becomes Your Building Permit When Approved
... 11 Receipt No. w
Da- V B
Building. Official Date i 3 /
1
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372