3665 Vermilion Ct NDate:
Tenant
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 =5694
RESIDENT / OWNER
CONTRACTOR
TYPE OF WORK
PERMIT TYPE
Applicant's Printed Name
2011 RESIDENTIAL PLUMBING PERMIT APPLICATI q
• _ Site Address: _ 1 t%1"' X)O
Name:
Address /City /Zip: a 6( o j \)‘2.4)0,AL 1 N
Use BLUE or BLACK ink
Permit Fee: ' s "
Permit e:
Date Received:
Staff:
Sulu tf:
Phone: 6 (a-' - / t
Name: ,MILBERT COMPANY INC.dba CULLIGAN WATER
Address: 1801 SOT" ST EAST City: • INVER GROVE 'UGT
State: • MN Zi 55 Phone: 65,1 . :4$L -2241
Contact BILL.MILBEET` Email:
• _ New Replacement Repair _ Rebuild _ Modify Space _ Work in.R.O.W.
Description of work:
RESIDENTIAL
Water Heater
Lawn trrigatiQn ( RPZ / _ PVB)
Septic System
New
_ Abandonment
4 Afater Softener
Add Plumbing Fixtures ( Main / _ Lower Level)
Water Tumaround
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater And Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (Incliides $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes 65.00 State Surcharge)
'Water Tumaround (add 6166.00 if a 5/8" meter is required)
6105.00 Septic System ($10.00 per as built) (includes County fee and 65.00 State Surcharge)
$95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes 65.00 State Surcharge)
TOTAL FEES $
J
CALL BEFORE YOU DIG. Call Gopher State One Call at (851) 454 -0002 for protection against underground utility damage.
Call 48 hours before you Intend to dig to receive locates of underground utilities.. www.000herstateonecall.org
I hereby acknowledge that this Inf¢rmatlon Is complete and accurate; that the work w N be In conformance with the ordinances and codes of the City of
Eagan; that t understand this is riot 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 } �the �approved plan, In the case of work which requires a review and approval of plans.
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Applican s • nature
From:ALLSTAR CONSTRUCTION 19529427464 09/03/2013 10:17 #482 P.029/043
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3 (955 , 3 c~ 5 t 3(Q 5`~ t 3 (0 (o I . 3 to l0 3 i 3 6~ 5 Use BLUE or BLACK Ink
- - - - - - - - - - - - - - - - - -
For Office Use I
UILY of Eajan ~ Permit # 113~rJ~ j
1
Permit Fee:
~ ~ 5a . as
3830 Pilot Knob Road
Eagan MN 55122 Date Received. 01
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff:j I
I
2013 RESIDENTIAL BUILDING PERMIT /APPLICATION
Date: V1112,015 Site Address: ,3(04*~~~,"►II_IOY1 CDUr1 NDY~ Unit#:
Name. Phone:
Resident/
Owner Address / City / Zip:
s
Applicant is: Owner Contractor
Type of Work Description of work: 1 L- foof A► A Y L- 51 ct m ~
66
Construction Cost: I 0-7, On Z) Multi-Family Building: (Yes / No )
Company: AIISt~~r ~,a(1Sj7UC~i0Y1 M;GIMeXhP_,Vli- Contact:_JQt I~7l~S~ead
Address: 5IL45 I[ xit""-A1 St. Wui ~ 103 City: Mull/ PI-A in
Contractor
1,
I State: MN Zip: c5c'>35~ Phone: 951-942.7 195H
License OCoW 1J Lead Certificate p T'
(ny -
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
i
$3 In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
I _Yes _No If yes, date and address of master plan:
i
Licensed Plumber: Phone:
Mechanical Contractor: Phone: t'
Sewer 8 Water Contractor: Phone'
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be c/assiried as non-public if you provide specific reasons that would permit the city to
conclude that they are trade secrets.
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.oopherstateonecall.oro
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.
Exterior work authorized by a building permit issued in accordance with the Minneso fate Building Code must be completed within 180
days of permit issuance.
x tl ~IS-~Z{ x
App icant's Printed Name Appti s Signat e
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