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4136 Ruby LaneSuite X: RESIDENT I OWNER • 'Narne ■Ov'\ Phone• — - 3-*Z1- • Address /City /21p: 413 Q A■ 4/141V 12 CONTRACTOR • Nanle:,MILBERT COMPANY INC. a CULLIGAN WA Address: 1801 50Th ST EAST City: .: INVER GROVE'.UG'T State: • MN '• Zip 55 Phone: • 65 .1 . ..451; -2241 • . Contact BILL.MILB111 • Email: TYPE OF WORK _ NOV , teplacement _ Repair _ Rebuild Modify Space Wofk k),R,O.W. _ Description of Work: . RE *IDENTIAL • ' . Water Heater W ater Softener PERMIT TYPE • ' Lawn trrlgatlpn (_ RPZ / PVB) _Add Plumbing Fbdtrros (_ Main / _Lower Level) • Septic System • • Water Turnaround _ ' _ New _ Abandonment . • • , RESIDENTIAL FEES: 355.00 Minimum Water • Heater, Water Softener, or Water Heater� Softener (Indudes $5.00 State Surcharge) (includes $5.00 State Surcharge) Fixtufes, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) (add $166.00 Ita 5/8' meter is required) • 1 ($10.00 per as built) (includes County fee rind 35.00 State Surcharge) $35.00 Lawn Irrigation $55.00 Add Plumbing 'Water Turnaround $105.00 Septic System $95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (Includes $5.00 State Sur ` J. .. TOTAL FEES; Date: Tenan CiLyof Eaaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (851) 675 -5875 Fax: (651) 675 -5694 011. 1011 Staff 2011 RESIDENTIAL PLUMBING PERMIT APPLICATION 'Applicant's Printed Name Site Address: s, Signature Use BLUE or BLACK In Permit ft: (J Permit Fee: Date Received: S '. N x531 CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 -0002 for protection against underground utility damage. CaII 48 hours before you Intend to dig to receive locates of underground utlflties.• )rww.000heratateonecati.oni I hereby acknowledge that Ink rnf rnadon la complete and accurate; that the wog will be In conformance Witt the ordinances and codes of the City of Eagan; that t understand this le not a perm0. but only en appiicitlon 'fora permit, and work is to start without a perm) that the work wdi be In accordance wlth the approved pia n In the caw dm* which requires a nNew and a • uy I of pi' Sep 30 13 08:55a LS West, Ilc 9522368445 p.7 Use BLUE or BLACK Ink I For Office Use t My Permit: of Eap I ; 1 Permit Fee: 3830 Pilot Knob Road Eagan MN 55122 Date Received: ; Phone: (651) 675-5675 I I Fax: (651) 675-5694 1 Staff: 1 I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: idlOt (3 Site Address: 2D 911-1, 4 IL LHle.- Unit: 1 Name:Wii 11~~~reW&45 dht) xl1ir~60 Phone: Residentl Owner Address / City / Zip: Applicant is: Owner Contractor W! ~d~'A~~i ir~✓t S~ti~tg~~S " r`IrU.`1 Type of Work Description of work l ^eAr- dl` Construction Cost: J~ ~l 1 Multi-Family Building: (Yes ! No j&k lie Company: Contact te &AJLrJ e Contractor Address: 2e u~ keOtle- City: kd~g1ieJ State: Zip: 5 U '7 Phone: LJt d ' ~71 - License bU J L1 D .1 Lead Certificate 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 City of 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 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 dlg to receive locates of underground utilities. www.aooherstateonecall.ora I hereby acknowledge that this information is complete and accurate; that the work will be In oonformance 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 Minnesota State B dldigg Code must be completed within 180 days of permit issuance. 91 x sit ti lN/! SL J. ' x Applicant's Printed Name Applica s Signature Page 1 of 3