Loading...
1864 Cliff Lake Ct - Irrigation MeterRESIDENT / OWNER Name: , AAA" ALA. A .mil! ' , • Phone: lr 69D Address / City / Zip: 6 / jMe- CONTRACTOR Name: © \ (P1-10113.16 ( License #: ' o? Address: - 773) 4 / ieS' City: d • State: Y' p: ! �� Phone: ' M !�/ ((Z � ��i Contact: ©.)61( . Email: ♦ I. 0 4 f a TYPE OF WORK _ New Replacement Repair 1 Rebuild Modify Space Work in R.O.W. _ _ _ Description of work: _ PERMIT TYPE RESIDENTIAL Water Heater Water Softener Fixtures ( Main / _ Lower Level) Add Plumbing Lawn Irrigation (1 RPZ / PVB) Turnaround Septic System _ Water New Abandonment RESIDENTIAL FEES: $55.00 Minimum Water Heater, Water (includes $5.00 State Fixtures, Septic (add $166.00 if New ($10.00 per Softener, or Water Heater and Softener (includes $5.00 State Surcharge) (includes $5.00 State Surcharge) Surcharge) Surcharge) TOTAL FEES $ $35.00 Lawn Irrigation $55.00 Add Plumbing *Water Turnaround $105.00 Septic System $95.00 Fire Repair (replace Surcharge) System Abandonment, Water Turnaround* a 5/8" meter is required) as built) (includes County fee and $5.00 State ductwork, etc.) (includes $5.00 State burned out appliances, C!ty of Eaail 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 011 RESIDENTIAL PLUMB! Date: 5 ':" 5 1 Site Addres - • / tC Tenant: Ltir Appli ant's Printed Name 1 x 11 Applica 's Signature Use BLUE or BLACK Ink Permit #: V 9 ‘9(41 Permit Fee: C 00 Date Date Received:' J 1 ) �E IT�TION Suite #: CALL BEFORE YOU DIG. CaII 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.orq 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 approval i p plans. FOR OFFICE USE COMPANY NAME: Blaylock Plumbing GoE 31 4th Ave So L 632 omv CONTRACTOR LICENSE #: COMPANY PHONE #: 61 2-869 -7531 COMPANY ADDRESS: CITY: Richfield STATE: MN Zl pti 5423 CONTACTPERSONIPHONE# :Dick JOB ADDRESS: ij "(e ciA L ( .., _ C &ME OWNER /OCCUPANT /CONTACT PERSON: ( kT �- / e p _ CONTACT PHONE; I _ � c� c BACKFLOW PREVENTOR RP TEST DEVICE LOCATION I'll" ro INSTALL DATE (MONTH /DAY /YEAR): FLOOR #: OVERHAUL DATE (MONTH /DAY/YEAR): i d 014 ROOM #: SERVES WHAT SYSTEM: Lii-f ,' N ) 4 )4 ) / t fi SERIAL #: `?) L t 7( t , TEST DATE (MONTH /DAY /YEAR): 1/ TEST BEFORE REPAIRS FINAL TEST #1 CHECK VALVE PSI /DIFF RELIEF PSI /DIFF #2 CHECK VALVE DESCRIBE REPAIR IF ANY (IF THIS IS A NE OF T DEVIFE REMOVEp): e »tY() i'C INSTALLATION AND REPLACES AN EXISTING DEVICE, INDICATE THE SERIAL NUMBER rY 3P TEST DONE BY (PLEASE PRINT FIRST & LAST NAME): Chad Fiskewold 1/19/2006 CERTIFICATION NUMBER: 65646 BF ATTACH THIS COMPLETED TEST REPORT TO PLUMBING /GASFITTING/RPZ PERMIT APPLICATION AND SUBMIT WITH FEE. 73