2107 Cedar Grove Tr, Unit 114
4
Use BLUE or BLACK Ink
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City of Eap
I ,
3830 Pilot Knob Road j Parmtt Fee: C
Eagan MN 55122 I
Phone: (651) 675-5675 Date Received;
Fax: (1351) 6754694 Stab ,
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Address:
Tenant;
suite
RESIDENTI OWNER Name: ~Jll1 ~ Phorw --t fL q
Address / CRY / Zip: a b ky
W I
CONTRACTOR Name:_ll!IILBERT COMPANY INC.dba CUWL WAN WATER
Address• 1801 50" h ST EAST Cllr : INVER GROVE li=
State: • MN_Zip; 55.077' Phone: 65,1 .::451-2241
Contact:- BILI..MILBE'T` Email:
TYPE OF WORK _ New _ Replacement _ Repair _ Rebuild _ Modify Space _ Work In.R.O.W.
Description wori
PERMIT TYPE REOLNT/AL
Water Heater Water Softener
Lawn Hgation L RPZ / _ PVB) Add Plumbing Fixtures Main Lower Level)
Septic System Water Turnaround
_ New
-Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Hefater, Water Softener, or Water Heater M Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (IncIddes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures Septic
System Ab doan rement , Water Turnaround* (Includes 65.00 State Surcha e
'Water Turnaround (apd $166.00 N a 5/8" meter is required)
)
$105.00 Septic System V_23~ ($10.00 per as built) pncludes County fee and $5.00 State Surcharge)
$95.00 Fire Repair (replace burned out appliances, ductwork, eta) pncludes $5.00 State Surcharge)
TOTAL FEES;
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 uanties.
I hereby acknowledge flat this Mt~rmsft is complete and accurate; that the work will be in conformance with the ordinances and codes 4 Qa City of
Eagan: Owl I understand this Is a permit. but only-an application ,for a permit, and work Is not to start without a por min that the work will be in
acdordancs with approved p In the case of work which requires s .review and approval or plans.
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Applicant's Printed Name Applicant's, igna re
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