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EAGAN
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 I TDD: (651) 454-8535 I FAX: (651) 675-5694
buildinginspectionsacitvofeaaan.com
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For Office Use /,,
Permit #: /__,---g ,2e/r
Permit Fee: 6,0
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REC E , ' `� ' 1 Date Received: /p _ ``-19
OCT 0 4 2019 Staff:
2019 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: /() `/� / Site Address: 6/ /b// (f (� IS �/ /( P
'P1S-7i � � S'0! .
Tenant:
Suite #:
J
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Resident/Qwner `
Name: li .s-4 A& --- 0 .1 S o v\Phone: 2- '(g- 6-/99?
7
Address / City / Zip: 'e-'16/ c'% (aLIW.'`�-2 d /_yL - D f�
Contractor
Name: 4 ef,___ /2/6.4.--,‘j„ License #: PC V/ "
Address: 9GT 3 7 0 LAe S .7. , P S City: C-�74.4 5 P G i U
State: V"l n Zip: "\----C-)/ ‘ Phone: 6 V-/- 7.-(Tcr' �/
Contact: Email: 2 f0 /(/rt --t 4'A %/14 r/ Q "J rh ^9 /CC).
Type of Work
New placement Repair Rebuild Modify Space Work in R.O.W.
— — — _ _
Description of work:
Description
Thankless Water Heater
Lawn Irrigation ( RPZ /— PVB)
Standard Water Heater
Add Plumbing Fixtures ( Main / Lower Level)
Water Softener
Description:
Septic System
Connection to City Water from Well
New Abandonment
RESIDENTIAL FEES
$60.00 Water Heater,
$60.00 Lawn Irrigation
$60.00 New fixtures,
$60.00 Septic System
$100.00 New Residential
$115.00 New Septic
$60.00 Connecting to
*Sewer & Water
Water Softener, or Water Heater and Softener (includes State Surcharge)
(includes State Surcharge)
adding or removing piping (includes State Surcharge)
Abandonment
(fee collected with Building Permit)
System (includes County fee and State Surcharge)
City Water from Well* + $290 for Meter and $190 for Radio Read = $540
Permit also required for connection charges
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 utilities. www.gopherstateonecall.orq
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeagan.com/subscribe.
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.
Applicant's Printed Name
x
Applicaajg Signature
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