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°, a e CITY OF PRIOR LAKE PLUMBING PERMIT
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INNESn 1. Blue File
2. Gold city PERMIT NO. 08, .98 J
3. Yellow Applicant
(Please type or print and sign at bottom)
ADDRESS ZONING (office use)
3a g a u. we 0 k- pri \& N vl _5537;
LEGAL DESCRIPTION (office use only)
LOT BLOCK ADDITION PID
OWNER
(Name) \0' 1 I< Ro$ wx. (Phone) 95 a - A SS- Li (
(Address) 3 a $ upu cQ ()v c..k (n N W
APPLICANT
(Name) C
CULLIGAN WATER CONDITIONING (Phone)
(Address) 6030 CULLIGAN WAY
(A 1 MN 55345 (City) (Zip Code)
i (952) 933 -7200
(Contact Person) (Phone) b
APPLICANT SIGNATURE DATE c1 - 30 - U g
APPLICANT PLEASE COMPLETE BELOW
Quantity Type of Fixture Quantity Type of Fixture
Bath Tub with or without shower Rough -ins
Dishwasher Water Heater
Floor Drain 1 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 $ A 00 .0 0 Building Permit #
PLUMBING PERMIT FEE $ 49 .50
STATE SURCHARGE $ .50
TOTAL PERMIT FEE $ _56 . 0 Q
(Office Use Only)
This Application Becomes Your Building Permit When Approved Paid Rece'p y¢y
Date By
Building Official Date 10_ Z (,,!/ •
24 hour notice for all inspections (952) 447 -9850, fax (952) 447 -4245
4646 Dakota Street S.E., Prior Lake, Minnesota 55372