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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. " l , `4•(••• • • 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 WO lc — ignature