4704 Lund PtRESIDENT / OWNER ;
Name: __2h 1 \ 6 th = Q Phone: 05 ] i c(3 3
Address / City / Zip: 1--t iist 1 ' tx. -r -,fri PIN 51
CONTRACTOR
Name: – License #: ` 0592-69—PH
•
Address: A _PIAt1C�
1313 Danifa
State: -- - - - iiok
pee, MN
Contact: Emai
, City:
5 O 3
553
:
TYPE OF WORK
— New 7eplacement Repair
—_ Rebuild - -- Modify Space ___ Work in R. O.W.
��-11 i .�-f VLf L `�► -
___
Description of work: __
PERMIT TYPE
RESIDENTIAL
Water Heater
Water Softener
Add Plumbing Fixtures (____ Main / Lower Level)
Lawn Irrigation ( RPZ / PVB)
_ Septic System
New
Abandonment
___
_ _ Water Turnaround
RESIDENTIAL FEES:
$60.00 Minimum Water
Heater, Water Softener, or Water Heater
(includes $5.00 State Surcharge)
Fixtures, Septic System Abandonment, Water
and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation
$60.00 Add Plumbing
*Water Turnaround
$105.00 Septic System
Turnaround* (includes $5.00 State Surcharge)
and $5.00 State Surcharge) j r O ;
TOTAL FEES $_
(add $189.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675- 5694
2012 RESIDENTIAL PLUMBING PERMIT APPLICATION
`—I l
Date: ?° Site Address:
Tenant:
2
Use BLUE or BLACK Ink
For Office Use
/4 #:
Permit Fee:
Date Received: _____
Staff:
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454 for protection against underground
Call 48 hours before you intend to dig to receive locates of underground utilities. `www.gopherstateonecall.orq
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 wilt be in
accordance with the approved plan
in case of work which requires a review and approval of plans.
Applicant' S gnature
Applicant's Printed Name
Suite #:
FOR OFFICE USE
Required Inspections: Under Ground Rough -In ` Air Test Gas Test Final
Reviewed By:
CITY OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:. —
Address:
Site Address:
Plumber:
Meter No.: — Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges: —
Total:
By
, r� Date Paid:
Date of nsp.: q �� �) Insp.:
CITY. OF •EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner: -- — — —
Address: - --
Site Address: — — Plumber:
agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.: — Total:
Insp.• — - Date Paid: —
Use BLUE or BLACK Ink
r
For Office Use
Permit#: I M1
City of EaROD ~aPermit Fee: 410.01
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: 1
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Q /2,13/13 Site Address: y161 XJVf'iJ7fC,405" J(7 40,
11704V Unit
Name: IV- Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner , K Contractor
Type of Work Description of work: 9e/~C DUI-
Ype
Construction Cost: Multi-Family Building: (Yes -9/ No )
4
Company: f/~~ 1r Contact: 45A M44.4 #401
Contractor Address: 13A0r , aRrie`d e4- City: IS~aXle
AI A State: AI A Zip: ~J7 Phone: ( I A "
License #:2 03 ~4 66 / Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: 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 (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.oro
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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance. ~y
X_ I~ t'049' 430 x
App icant's Printed ame A ant's Sign ture
Page 1 of 3