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Zoning: No. of units: 3 i Z t: t 't 6 .
Address: -
site / 1 " 1-et ?o ?tt 1.4 ';� > fc: � eel jf rc 4 t 3,
phmaber: 2 r
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L Deposit:
P Foe: 0 re
Date Paid:
r For Office Us
%� Permit#: f / 737
E AG N
VCS
Permit Fee:
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff:
buildinginspections aC�.citvofeagan.com
l /2020jRESIDENTIALPLUMBING
e
PLUMBI/NG PERMIT APPLICATION
Date: / _` °M Site Address: < 6 / o. 5 / "I--
Tenant: Suite#:
Resident/Dfher
Name: / l/ �./ Phone: O/,) ' ✓��6��
Address/City/Zip:
Name: //)'c‘✓ ' -7;2 L License#/T 70 3 70z 3
Contractor Address:�.690/ 714.( City: /9//�D�/7
-
State: /P Zip:53_?c 3 Phone: 4-,/,2 e))../ 0
Contact: //Y7 Email:
Type of Work —New )(Replacement —Repair —Rebuild —Modify Space —Work in R.O.W.
Description of work: �f
Tankless Water Heater
Lawn Irrigation( RPZ/—PVB)
/ Standard Water Heater
Add Plumbing Fixtures( Main/—Lower Level)
Description Water Softener
Description:
Septic System
New Abandonment Connection to City Water from Well
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 New fixtures, adding or removing piping (includes State Surcharge)
$60.00 Septic System Abandonment
$100.00 New Residential (fee collected with Building Permit)
$115.00 New Septic System (includes County fee and State Surcharge)
$60.00 Connecting to City Water from Well*+$290 for Meter and $200 for Radio Read = $550
*Sewer&Water Permit also required for connection charges
TOTAL FEES$
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.citvofeaaan.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
E. - ; that I understand th' is not a permit, but only an application for a permit, and work is not to s withou - . it; that the work will be in
a,cordance wi • • -d plan i case of work which requires a review and ap.royal of pl..
x i// x
can nted Name •pplicant'- ignature
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