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
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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
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