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1866 Ruby Ct NRESIDENT / OWNER Cagan, IVIIV SS ILL Name: 6516862847 lone: Address / City / Zip: CONTRACTOR nn Name: NO.RBLOM PLUMBING Co. L icense #: ©tl/ 1 Address: (612) 8274033 City: 2905 GARFIELD AVE. SO. State: Zip: MINNEAPOLIS, MN 55408 Phone: Contact Person: TYPE OF WORK New X Replacement Repair Rebuild Modify Space _ Work in R.O.W. _ _ Description of work: replace, V wafer heater PERMIT TYPE RESIDENTIAL 1 Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures ( RPZ / PVB) ( Main Lower Level) _ ^ Septic System Water Turnaround New Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation $50.50 Add Plumbing *Water Turnaround $100.50 Septic System $90.50 Fire Repair (replace (includes $.50 State Surcharge) Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) (add $165.00 if a 5/8" meter is required) New ($10.00 per as built) (includes County fee and $.50 State Surcharge) burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) (� TOTAL FEES $ *' City of Eaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Tenant: Site Address: Juanita Stevens 1866 Ruby Court N. x \Je L-. Nork2it o Applicant's PrintetrName JUL 0 1 2011 A•,'icant's Signare Permit #: 1 Permit Fee: ` 0 6 Date Received: 2009 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: L ( 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 of plans. 1 Staff: L Suite #: Sep 30 13 08:54a LS West, Iic 9522368445 p.4 Use BLUE or BLACK Ink i 4b~ I For Office Use ' Cq of Eap I Permit Fee: 3830 Pilot Knob Road t i Fagan MN 55122 Date Received: t Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I t I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: t~~f)I1~3 Site Address: / ~~b-H Unit Name: , T tl vvrw+c:~ S h }fr~ 1~1 Phone: Residentl Owner Address! Ctty / zip: Applicart is: Owner Contractor Description ofwod l e!&r- Ott- Uebvupb~m Sb1441 e.S Type of Work A~ _32C _71C1 Construction Cost: 3 • Multi-Family Building: (Yes ! No Company: L , W ~'S~, ! (V Contact: iebA dlr'1 ~e ~~eJ Contractor Address: , bq 2e e~tu~ City: Ld 0, State: Zip: y a LtH Phone: 61 ) - ~72 " 4 License ~.l~61 .1 Lead Certificate t /y , _ If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the Cityof Eagan issued a permit fora similar plan based on a master plan? Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public M you provide spec reasons that would permit the City to conclude thaf they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (551) 454-0002 for protection against underground utility damage. Call 48 hours before you Intend to dig to receive locates of underground utilities. www.ggpherstateonecall.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 worts is not to start without a permit that the work will be in accordance with the approved plan in the caseof work which requires a review and approval of plans. Exterior work authorized by a building pemtit issued in accordance with the Minnesota state uitding Code must be completed within 180 days of permit issuance. x ~~5 ~ x Applicants Printed Name Applican ' Signature Page 1 of 3