3608 St Francis Way Unit ASuite #:
RESIDENT / OWNER
Name: 5tSe Q 1 Phone: 16 / 5W _5c (2
7
,U / C1
Address / City / Zi
`
CONTRACTOR
Name:.MILBERT COMPANY INC.dba CULLIGAN WATER
Address: 1801 S0TM ST EAST C INVER GROVE HGTS
State: _ MN Zip :''' 55 Phone: 65,1 ::451 -2241 Ntir
Contact BILL .MILBERT:; Email:
TYPE OF WORK
New eplacement Repair Rebuild Modify Space Work In R.O.W.
_ _
Description o work:
RESIDENTIAL
Water Heater ?hater Softener
PERMIT TYPE
Lawn Irrigation L_ RPZ / PVB) Add Plumbing Fixtures (_ Main / Lower Level)
_ __
Septic System Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation
$55.00 Add Plumbing
*Water Tumaround
$105.00 Septic System
$95.00 Fire Repair (replace
(includes $5.00 State Surcharge)
Fixtures, Septic System Abandonment, Water Turnaround" (includes $5.00 State Surcharge)
(add $166.00 if a 5/8" meter is required)
New ($10.00 per as built) (indudes County fee and $5.00 State Surcharge)
bumed out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $ S J e eV
Date: J
Tenan
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
r rT
Permit #:
Permit Fee:
Date Receiv
Staff:
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Site Address & ®U QQ •St / a l / S W U� i * A .
Applicant's Signature
Use BLUE or BLACK Ink
-,
CALL BEFORE YOU DIG. Cali 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.aonherstateonecall.ora
1 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 1 understand this is riot a permit. but only an application for a permit, and work is not start without a permit; that the work will be in
accordance with approved plan In the case of work which requires a review and approval of plans
Applicant's Printed ame
Oct 2 2014 12: 05PM Crest Exter ors 651-463-8095 P, 4
Use BLUE o��LACK Ink
_�
� For Offlce Use �
' j Permil#: � `��� �� j
Clty of �a�a� ; Permil Fee: r /�_ �� �
3630 Pllot Knob Road � �
Eagan MN 66122 � Dale Recei�ed:�� j
Phone:(661)676-567b � �
Fax;(661)67b•5694 I Sta�: �
I
�_________...����__J
2014 RESIDENTIAL BUILDING PERMIT APPLICA710N
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Date:'� Site Address: Unit#:
Name:CI� �� ��I���� J�� _Phon�LV�,�JI�J�I�1` (l,�l�
'���/. r` �, � �
�" ,0', Bt Address I Gify/Zip: Q�
.�::<�,.. ., . . .
.�Sa�,:���,:.��::� Applicant is: Owner Contractor
� ���F.t. ' �� p
z '• Description of work: 1�--�C�- '
� .e.�Of�
.� �I..� �� �.
• �� Construction Cost� ZW �� Mul6-Family Building:(Yes�/No�
. •, • Company:\��jl _ �1 Y,������l._-�. i _Contacl: I�lJ1��/ _
, .- `� ;c�„e-w�.: Address:�7�h�_Ci�'��Y� / 1 � �\'r -- City: . � �
��nfra��,or.•
�:�; . (
• - • State:�Zip���_�'�' Phone: � I�ma��:(XQ,S .1�1�C� �r1t1C�C��r��
License�l:C)��U1�}-� ��� �. Lead Certifica[e#:
If the project is exempt from lead certiflcatlon, please explain why:(see Page 3 for additional information)
' r �
�� f �' il�� �^4 . �� �l � `� � , � ,
COMPLETE 7HIS A A ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the Clty of Eagan issued a pemtlt for a similar plan bseed on a master plan7
_Yes _No If yes,date and address of master plan'
Llcensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contracfor: Phone:
IV. TE:Plans and:s�o►��ng d cuirie tis"ina'� � -�re°'o" - � ���e' u611c informafion. Portlons of
t e'ihfontl"�e��li�mayb�e�classife �. ► e,,. , _,�,., ��d,f�vould�permiftHe�Ci(y�o
�
� • �co - re e s:->
CALL BEFORE YOU DIG. Call Oopher Slate Ona Call ai(861)454�OOOP lor prolectlon againsl underground utllily damage, Call 4B hours
before you inlend lo dIg lo�ecelve locales oi uhderg�ound uUllUes. www.000her laleonecall.ora
I hereby acknowledge Ihal lhis Infofmal�On Is complete and accurale;lltal Ihe work will be in con(ormance wlth lhe ordinances and codes of the City of
Eagan;Ihal I undersland lhis Is nol a permii, but only sn appllcaUon for a perrnil, and work Is not to slert w+lnoui a permll; thal lhe woAc wlll be in
aCCOfAance with the approved pian In ihe case of work which reqUires a reNew and approval of plens.
Exterlorwork authorizad by a bullding pertnif is6ued In accovdance wlth lhe Minnesoia State Building Coda must be completed�vitnln 180
days o1 permll Issuance.
.
X � �.�r��� � c,4��_, X
ApplfcanYs Printed Name Applic nts Igneture
Page 1 oF 3
Use BLUE or BLACK Ink
For Office Use 'y
Permit#: ���(/
City of Eaaall Permit Fee: ( .9
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone:(651)675-5675
Fax:(651)675-5694 Staff:
J
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 3 hs r/i Site Address: 3 o 5� %•l "e=� (ec/� Unit#:
rp
Name: <�e /lY Phone: 6'3 A6 Ys .2374.
URes®�
Address/Ci ty/Zip: 366" -} lAs efc " 4
d0 Pci "�
i � Applicant is: Owner A-Contractor
P 1,41. Description of work: /' irt
*4;11413i ofW• ,
_ 'ql Construction Cost:"'°
37 Multi-Family Building: (Yes "( /No )
company:6'.G& r 17/4, 2,(2a,rEontact,..>
Contractor - Address: 6646 3 3 SDT 42 S, a - City: 4''
,,�k� pk State:jrin Zip: Se' 2 Phone: c$!AAU i—'icmtmail: Se,Jc4-6�5cree��� t'!✓,.��t s. 4.,r , .
License#: ..'70 f 3 Lead Certificate#:
If the project is exempt from lead certification, please explain why:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the City of Eagan issued a permit for a 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:
Fire Suppression Contractor: Phone:
NOT �{;' Tans nd support! ' ... u I� � '. a �I
1 o 1 "v 0 ,,,, ® •trcun7e i S ! at Y, 1 11't t CORS�r evt 141 i0 i)
t
h lnfa en •sstfi••, loon-• tic'if u •vi k Heci reasons that wawa Prri th , t f
9u� N Fziili t� q �� ( t�ly�- dir�1�.P Q � v '�f "'11 ' 7 � Mt aR
fir aq�r` : ii 4 + on . .that ` : =de secrets. 1,1 p
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.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 of plans.
Ex = orized by a building permit issued in accordance with the Minnes• - . _. ding Code must be completed within 180
•ays of permitance.
x ttja. x - ,r
is 'rinted Name App Ica ,!"Signature
Page 1 of 3