3176 Alden Pond Lane�EFt it AI'EFt;l(
Q lEAi3AN
30,Pilot Knob Rd.
P.O. Bc 2li
Eagan, 1.121
IDENTIAL'
UMBER.• afl1al ,.
: % tai wa ' X 1 AGREEIY OF
t"dTY,'STATE p 55369
PHONE
Date:
City of Eaill
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651).675-5694
flECEIVE
MAY 3 U 2020
BY: A --t°
dott-c4 creme
Use BLUE or BLACK Ink
For Office Use
Permit #: /025 / to
Permit Fee:
Ga.aa
Date Received: 0.,;/)3� - /4A
Staff:
2014 RESIDENTIAL PLUMBING PERMIT APPLICATION
_14
Tenant:
Site Address: 31°Ilf 01)"41"-1714
6
Name:
Address City / Zip: ,‘
Suite #:
Phone::54)--V1 - I '/ tJ o
b1) , s/: j
Milbert Company Inc dba Cullign
Name:
Address:
1801 50th Street East
Water
ucense #:
state: : MN Zip: 55077
WC643176
City: Inver Grove Hgts.
Phone: 651-451-2241
Contact: William R Mi l b e rt Email:
New _ Replacement _ Repair
Rebuild
_ Modify Space _ Work in R.O.W.
1
Description of work:
RESIDENTIAL
Water Heater
_ Lawn Irrigation ( RPZ / _ PVB)
_ Septic System
New
Abandonment
Water Softener
Add Plumbing Fixtures ( Main /_ Lower Level)
Water Turnaround
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge)
$60:00 Add Plumbing fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $200.00 if a 5/8" meter is required)
$115.00: Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) doe
TOTAL FEES $
CALL BEFORE YOU DIG, Call Gopher State One CaII 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.copherstateonecall.orq
I hereby acknowledge that this informa:ion 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 s - ithout a permit; that the work will be In
accordance wh the approved plan in the case of work which requires a review and approval of pla s.
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Appiican 's Printed Name
Applicant's Signature
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