3242 Alden Pond Lane SIFE# d� E SLY
' K - IT DATE
PEFiA+114 9/22/89 _
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09/25/2018 21:47 6519948701 JANECKYPLUMBING PAGE 01
For Office Use
EAGAN
.._- _.. Permit Fee:
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Date Received: f 2 I i
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-56751 TDD:(651)454-85351 FAX:(651)675-5694 Staff: J
buildinginsnection. cityofeaaan,com L
2018 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: • G� Site Address: tSt� `1 A-e at + ' / 'is
Tenant: Suite!t:
Name: _Phone;
Address/C' /Zip:
/
Name: License#:
Address:
r , `/7O 1,1-4114---- �l kart„: h'1.1 ;6o W 5
State: ! -Zip; `�0 Phone: UVf'� "Z .fit
'A, ,•,..;,Y'. '� rted*kC /Email: /4,1/tsG Me l)r i-4 —"'�[
„�>. i;:..::i ...:x,';.,•,.,' Contact:
`' •,.`' i New eplacement _Repair Rebuild Modify Space _Work in R.O.W.
Description of work: ± /06(4/1144(4 Kms-- pl
RE8IDENTIAI, `�.!)
Water Heater
` ''l:m:;;;• ,;; Water Softener
Lawn Irrigation( RPZ/,PVB)
Add Plumbing Fixtures( Main/ Lower Level)
Septic System ----
-° New Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,Water Softener,or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation(includes State Surcharge)
$60.00 Add Plumbing Fixtures,Septic System Abandonment,Water Turnaround'(includes State Surcharge)
'Water Turnaround(add$280.00 If a 3/4”meter is required) ,0 U
$115.00 Septic System New(Includes County fee and State Surcharge) TOTAL FEES$
CALLBEFORE YOU DIG. Call Gopher State Ona Call at(851)4540002 for protection against underground utility damage. Cell 48 hours before you
intend to dig to receive locates of underground utilities. www,000herstateonecall.Qrg
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the Clly's
website at www.citvofeeaan,00mrs_ubscribe.
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 en application for a permit, and work is not I• - without a 41; that the work will be in
accords isrliZa approved p At
tthhe cease work which requires a review and approval plans,
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Applicant's Printed Name Applicant's Signature
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