3436 Highlander DrJun. 8. 2011 2:45PM SELA ROOFING
City of EaQali
401'
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 676-5694
cr*dW-
No.6530
P. 14
Use BLUE or BLACK Ink
Permit Fee: /336- d5
Date Received;
Staff:
20'1'1 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address: fit' , '[ .(5S&3, t # ` ro..!
*5'u -4 -dee
RESIDENT
OWNER
Name:
�,4 Ill/ �i►{.D lbi�.f�C�hone:q'� ! c
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U/��
Address / City / Zip: �'�' j(470 M7 D7,, , it / .
Applicant is: Owner X Contractor
TYPE OF WORK
Description of work: '11 _ 4,1 / �. a — f K
N;
Construction Cast: ft I . Multi -Family Building: (Yes No )
CONTRACTOR
_
/�_/
Company: i 1 L J t Contact: / VINQ 1CJ 6-
Address; 4100 / t, Q - Cityc �.f�f�%i J
/fir /D
State: , v� Zip: 65'-f' l [L.� Phone: -L(/ i --C/:tJcR_3-i g g--7
License #: ofrO Lead Certificate #: AM i C11.d T — 1
If the project is exempt
from lead certification, please explain why; (see Page 3 for additional information)
In the last 12 months,
Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan;
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NWT: Plans 'and supporting.documents:that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that,.would permit the.:Ciiy.to
' conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One CaII 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.popher on call.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 art 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 • piens.
x M 1I i .JV`1O .L
Applicant's Printed Name
.4
Applicant's Signa : re
Pagel of 3
'CITY EAG
-3795�fot. ICnol
SEWER SERVICE
(dress`
e. -Address.'
I agree to comply with
Ordinances.
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
2014 RESIDENTIAL PL
Date: - . � 1 Site Ad' ss: �p
Tenant:
FFP 12 2014
Use BLUE or BLACK Ink
For Office Use
Permit #: I Ot 1)4"
Permit Fee:
Date Received:
MBING PERMIT APPLICATION
xi1.4 ®ntr ryT ® �,
Phone: i
Name: /•
+'Cit / i 4
ZAddress
Milbert Company Inc d.a CuIIi n Water !I
Name: ucense #: C643176
Address: 1801 50th Street East City: Inver Grove Hgts.
State: M N Zip: 55077 Phone: 651-451-2241
Contact` William RMilbert Email:
New Replacement Repair _ Rebuild Modify Space Work in R.O.W.
—
Description of work:
'Septic
y.,
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation ( RPZ / PVB)
Add Plumbing Fixtures L. Main / Lower Level)
—
System
—
Water Turnaround
New
—Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,
$60.00 Lawn Irrigation
$60.00 Add Plumbing
"Water Turnaround
$115.00 Septic System
Water Softener, or Water Heater and Softener
(includes $5.00 State Surcharge)
Turnaround* (includes $5.00 State Surcharge)
and $5.00 State Surcharge) Oa
TOTAL FEES $--�i
(includes $5.00 minimum State Surcharge)
Fixtures, Septic System Abandonment, Water
(add $200.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee
A'
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. aopherstateonecall.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 approve of • ans.
// z/49
x
Applicant's Printed Name
x
Applica
ignature