P - 60339�u�i�-uirY� i �'�-�,TI�!����aa-� j 6e�-m;� r�o.� '�
„ • �, �T- -, r-,r � �,-,� i �:
�T2S�p��1� � i "��LLi'�.�` �. �:..� � �_�'�7.��.1i�!� � �'��� i Receivec; 8�,. �
ji, . _ r•t)L � ,t--rF�T ° � T`a � i^ �
r^ .aF�^^ %
��� � �.�� ��T��r':���` . ;�ate �en-M.
%��-JZ�: . � . . _ �.� 1� � Gl�, r TrvE ?oi^_ ! f ,G.
e �" �3" �a` � YOUP E-A�IAIL :`.D�1'tE5:> . ��
r�, ���r-_
srrL 1�ui:�sc. 1 oY3 � ll.�r2 C��c(�2 NE
THiti APPLIC ;�IT IS: ❑ OWiJ�R �!'ON"t'IZA��TOi: ��I
pI��1��,''y2'��' i 1JAMG: O 'I
����� .1DDP.L'SS: ID Ft rri0✓Q C� �G �'P � CITI'_[F d i� S"I'ATL. %�.Z1YS.S� �pZ- �
������` I PHON G: ���Q ���%- o a 6 5 „
C�N�'I'.Ac�'oR Nf�ML Kc�re r' C.,�w
SUI�Mft' �1 COPY OI=
YOUI� STATL STAT� LICLNSG # EXP DAT�
I,IC�NSE, 130ND AND STATE BOND # LXP DATL
c�RTiricAT� or �D�r<�'�,,��1 p ma.,i� S�', �'39 ciTS� �r� d l�ti sTr T�rlt �'1 ziP �P3a-'
iNSUrz�NC� PHONE ����- 755�- a-t99 r�x "TG3 - 7S�- �g08
PERMIT TYPE
TYPE OF WORK:
�INGL� FAMILY
❑ N�W
DETAILED DESCRIPTION OF WORK
❑ TWO PAMILY ❑ TOWNHOUS�
�TtEPLAC�MENT
��1
�/O
FEES ARE BASED ON $] 0.00 PER FIXTURE, �XCEPT WHEI2� NOTED. FIXTURES: (INDICATE TOTAL NUMBER•,OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINK/LAV FLOORDRAINS SHOW�R WATERPIPING
BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35)
CLOTHES WASHER KITCHLN S1NK WATER CLOSET BACICFLOW PREV. ($15)
_ DISHWASHER _ LAUNDRY TRAY ?WATL-R HEATER ($35) FOR IRRIGATION
WATER METER OTHER
State Surcliarge, $- " 5:0.0 .
(MINIMIIM $40.00) Total = $ �0' �
THIS IS AN APPLICAI'ION FOI:AP�RMIT-�OT VALID UNT7L PROCLSSL-D
1 I�ereby �ppl}� for a pl�imbing permiC and I acla�owled�e t�riat'the information above is complete and accurate; Yl�at the worl< will be i��
conformance �vith the ordin�mces and codes of the City o' Pri ley and with the Nlinnesota Construction Codes; ihat I understlnd this is
not a}�erinit but only an applica�ion for a permit and wo�i- i not Co start withoul a periniC ou site; Ch�i t�he worlc will be in accordai�ce
��vith tlie approved i�l�n in th� � e uf �11 � : which requ r review �tinci unproval o"rj�lans.Q
SIGNATURL Ul� ;APPL1C,ANT PR JnMG �h �'! S /14.D� U����- �'�^L
\P�'�t(?l�rs.f„NSPse""'(lRSSTGIS'A'SiJR� i�A'fi; �-
'L���:�'�.�E ^JGT��: SEP .R:. "E ?�?Zi1���( � „� ARL' ' � ; [RE.. !'{�`R �UiL�J1i��(.i, t;L�;CT^��[C,=:L �vv ;;II�..i��r1��J1C..'�:; �N(} .1�
� --._.,A�T �" '� . ���4i
.�a�1�£..",'Ildh".; ��ll���"�:Q3��" ��P',���"`e'flT�'HIlL
�u� I :��ai�ie .,�r�. ,=�.��e,�u� ��f �. ��-_G1��. ,�iil�,i -='`'�-
;'6�-� 7=-;60=
,�.1,. 75�-�,i;�- :a,,.