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2160 Water Lilly LaneRESIDENT / OWNER Name: Z i c l,', OLA..SL Ae.._ Phone: 61Q- SS 5" 2 316 - Address / City / Zip: 21 ,. cut ed i i I a ' _ AAA) • S I '.Q. CONTRACTOR -- Name: Irt21011 OYVJ_ 4S (4 04 VAN License #: 513 q 55 •-p Address: / q I 05 5I /UF- City: Pr10 r" )- c)IC -e_ State: YlikAi Zip: 553 Phone: 'Y52 s2 - (-16 `!- 0 3q Contact: I G kR�. �.I - 1IA. Email: TYPE OF WORK New i( Replacement Repair Rebuild Space _ Work in R.O.W. _ _ Description of work: ' ' ' )# - - PERMIT TYPE RESIDENTIAL , i Water Softener Water Heater Add Plumbing Fixtures ( Main / Level) _ Lower Lawn Irrigation ( RPZ / PVB) _ Water Turnaround Septic System New _ Abandonment RESIDENTIAL FEES: $55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcha erg ) $35.00 Lawn Irrigation $55.00 Add Plumbing *Water Turnaround $105.00 Septic System $95.00 Fire Repair (replace (includes $5.00 State Surcharge) Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) (add $166.00 if a 5/8" meter is required) New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) TOTAL FEES $ 2 . 6:— City of Earn x i^ 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 2011 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: Site Address: 160 2 I E . ✓L. .tJ 5 Tenant: L Se-s._ LAsketz- CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and appro of plans. Required Inspe aril 0 Applicants Printed Name Under C RCi= ¢ FEB 072011 Rough -In plicants Air Test Gas Test Use BLUE or BLACK Ink Permit #: / q j 5 Permit Fee: Date Received: Staff: Suite #: FOR OFFICE USE Fi nal"