3492 Greenwood Ct SAug. 1. 2012 12:36PM Sela Accounting No.1661 P. 5
Use BLUE or SLACK Ink
Date;
City of Eaall
Per Office Uee
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Permit #:
Permit Fee:
4-26/-
3830
3830 Pilot Knob Road
Fagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 Staff:
J
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
11 site Address: 39 S6, 3 / 3'/91) 3y9Gretnwoed C-* S Unit#:
RESIDENT/
OWNER
Name: tffi tql„} �tS,
5 i✓i1 uwre. a :5;to C. Phone: (I -&3H - 11-3 3
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Address / City! Zip; to VI )3? L.�',/ LJc' '+ 1"ir_,- iy
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Applicant Is: Owner x , Contractor
TYPE OF WORK
Description of work: le- �C C)C> C-'
p
Construction Cost: t D9��S - 00 Multi -Family Building: (Yes / No _)
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CONTACTOR
Company: c""
CAA_ 2L�O -\4 11(1 C.,1N6111 1 t ►I1 Ci Contact: Kar'‘ '^`
Address: L{lCO fll,XCe..1 S't 0 Q1 V -, J City: <LUI.” Pa 1"'l_
State: MY\ Zip: 55u) I (v Phone; q 6J -A. -c 1 5 -- -7,1D.
License #: CG l2 OW U 5 0 Lead Certificate*: A/A T— a 5 U 3 L/ —
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
in the last 12 rnonths,
Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan Issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
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 (661) 464-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig (o receive locates of underground utilities. yrww.gooh rstateonecall.orq
1 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 wall (he approved plan in (he case of work which requires a review and approval of plans.
Exterior work authorized by a building permit Issued in accordance with the IVlinnesota State Building Code must be completed within 180
days of permit issuance.
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Applicant's Printed Name
Applicant's Signature
Page 1 of 3
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May 01 2013 4:O1PM BRUCKMUELLER PLUMBING INC 6516882160 page 1
Use BLUE or BLACK Ink
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CityofEaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
For Office Use '�]
Permit #: i)Dr!
Permit Fee: Loot.'
Date Received: 5 -2 ,13
Staff:
INFLOW & INFILTRATION PERMIT APPLICATION
t/ Plumbing / Sewer & Water
Date: 5-1-13 Site Address:.3e4q. So 1#44-11 Greenwao d Court
Tenant: Suite #:
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Name: Lo/fl2,%)L 5i%(i)9,ieaCer .tr- Phone: L.5/-4-15a"/To/
Address / City / Zip: 2 L/1 a2 50 (pill 6feOn wove/ Cour-14, gdyan MA)
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License #: 0 % 1 $ 5 1- pin
Address: !qq / el7/15;ri/1% 21%/ l a" i fi
City:
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State: MA) Zip: '�7.r� �.',� 3 Phone: 6,51- ($ (it - a a (.1,�r�sr
Contactr/ or lit // Email:
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PLUMBING (Within the building envelope)
✓Sump Pump Repair
SEWER
& WATER (Outside the building envelope)
Repair
Other:
Other:
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Description of work: / Ltln um
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FEES
860.00 / Each (Includes 85.00 State Surcharge)
TOTAL FEE $ t, D • 00
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 111 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeaaan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. CaII 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.goDherstateonecall.org
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.
x la I /`� J r Li me r.&der
Applicant's Printed Name
X ran ,
Appli ts Signature