3589 Blue Jay Way - Unit 101Jul. 1, 2011 2:42PM
4 City of Eatall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 575-5694
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 7/ /// Site Address: 0:25 /'<' 3 j (.c)(7.,"
Tenant: _eejIL1/_25::
Suite #: 10
•••■
RESIDENT ! OWNER
CONTRACTOR
Name: kr el if
Address / City / Zip ! : 1".)
Name: fLit PX)reA.Z1, License #; (1)
Address )(/? '7 City: gi (
State: fl" r-) Zup :::4 Phone: 6: 1 P. **-
contact:e Email; 0. "
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New Replacement Repair Rebuild Modify Space Work in R.O.W.
Description of work: 6( '...;0k/ Ae.4.1c,L, /4<x)k.e..1?
Phone:
TYPE OF WORK
PERMIT TYPE
•■•■
RESIDENTIAL
e:›Weter Heater
Lawn Irrigation ( RPZ / PVB)
Septic System
New
Abandonment
RESIDENTIAL FEES;
$55.00 Minimum Water Heater, Water Softener, or Water Heater Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Al lot„Iment Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $166.00 if a 5/8" meter is required)
$105.00 Septic System Ni ($10.00 per as built) (includes County fee and $5,00 State Surcharge)
595.00 Fire Repair (replace bumed out appliances, ductwork, etc.) (includes $5.O0 State Surcharge)
TOTAL FEES $
Permit #:
Permit Fee:
Date Received:
Staff:
No, 9476 P. 2
Use BLUE or BLACK Ink
Water Softener
Add Plumbing Fixtures ( Main / Lower Level)
Water Turnaround
.1
11.11.1■■
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 464-0002 for protection against underground utility damage.
Can 48 hours before you intend to dig to receive locates of underground utilities,
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 n o-start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review end ap f a
Z.. S.
Applicant's rinted Name
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