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Use BLUE or BLACK Ink
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I For Office Use ~j
; Permit
City of EaRd 15
I Permit Fee:
3830 Pilot Knob Road I i3 I
Eagan MN 55122 I Date Received: I
Phone: (651) 675-5675 I f1
Fax: (651) 675-5694 I Staff: V, I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: I Site Address: q0- l 4 Unit
I Name: Al Phone:
Resident/ v,3~ C r FC v1 AM ►J 4_U 2 Z
Owner ~ Address / City / Zip: ~ t"
Applicant is: Owner `V Contractor
Description of work: P\", '
Type of Work i
j Construction Cost: 171 (.Q DO Multi-Family Building: (Yes //No
)
i Company: Contact: L~ 3` 3 ~3
II L tom -drag -10 L ~
Contractor Address: :D36 i) 77 t.~ City:
State: Zip: l~- Phone: % - e 7-x{777
' License Lead Certificate
certification, please explain why: (see Page 3 for additional informati/on)~
If the project is :7 mpt from lead
I ~t lam' Cl` ~ V\ V d~~ J L fiC~ ~Dw' , 'il 1 ,
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
j 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._qopherstateonecall.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.
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.
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X
Applicant's PriAted Name ure
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA126669
Date Issued:09/05/2014
Permit Category:ePermit
Site Address: 4152 Knob Cir
Lot:022 Block: 02 Addition: Knob Hill Of Eagan
PID:10-42500-02-022
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Tony Boerner
2090 County Road 42 W
Burnsville, MN 55337
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Patricia A Roberts
4152 Knob Cir
Eagan MN 55122
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature
"L` ti—r .�... ' .. . ' .
Use BLUE or BLACK Ink
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� , � For Office Usa j
� ' ' _ia���i �
. �. � Clty.:of`�a�a� ;f� `` .: �., >� i Pertnit�: �
� I
. � Permft Fee: �° I
383�0 Pilot Knob Road � i � � / i
Ea an MN 55122 . i Date Received: 1 �
Phone: (651)675=5675 �
Fax: (651).675-8694 � statt: i
' �������� �������J
. 2p14 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Addresa:
Tenant: Suite#:
� J��a,� r�� Name: D 6 � b
��� k�� .. o �. �,a� 0 7a
��Re'sidentlO�wn�� � . Phone:
� , �� fip� ": Address�'CitylZip:_���� /�La� (�/'�-.
����,.� � }��� ` Milbert ompany Inc dba Cullign Water
x ��� #��;�' Name: ". ucense�: �NCG43176
� v� ; � . .
�� ��� ��-� ° �� � 180150t. Street East
� c'o�t�ac o '' ' Add�ess: c;ty: Inver Grove Hgts.
�a� �'a��4��� +�� �.state;. � N z;p: 55077 Pnone: 651-451-2241 .
�'" '�*� "� �`
� , .
���� ,��+� ,,��, �, � .Contact:� W I I I I a t11 R:'M I�b 2 t� Email:
�� � ���.
� "�' � h _New eplacement _Repair _,,.Rebuiid _Modiy Space _Work in R.O.W.
��YPe of.�Wo�.� �
A,S; .�� ' ,� - �� Descriptton of work:
� �" �� � RESIDENTIAL �
f .� �
�`� � � �
°��, Water Heater
�-� :•��� �,4��. Lawn Irrigation(�RPZ/_PVB) �Water Softener
•ae����'�� � � Add Plumbing Fixtures�Main/_Lower Level)
3 ����,?��, Septic System
, � �a� Water Tumaround
r � � NeW
,� ' ,�a� • —
�:.
� , ,�Y ��;.� � Abandonment
.:RESIDENTIAL FEES:
;:$60":OO Wa4er�Fieafer;=:lNater Softener,or Water Heater and Softener(includes$5.00 State Surcharge)
� ` :$60:00 �aviin:�lrrigatio�ri.(includes$5.00 minimum State Surcharge)
$6:0�00.Add.'Pl.u'rrtliing�Fixtures,Septic System-Abandonment,Water Turnaround'(includes$5.00 State Surcharge)
� .:. ."1Nater"a`umaround(add$200.00 if a 5/8"meter is required)
$1tS.OD�Septic.Sv§ferrt New($10.`00 peras�built)(includes County fee and$5.00 State Sul'charge)
� ' � TOTAL FEES 3
?CALL:BEF:ORE:YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage.
�Call:48�hnurs'befareyou int�nd to dig to receive'locate§of underground utilitie8. wvvw.QOpherstateonecall.om
i�.ti�reby acknowtedge`ftiat this lnforma:fon is compiete and�accurate;that the work wfll be In coniortnance witb the ordlnances and codes of the City of
� Eagen fhat-I'understand:fhis is not a,permi�but ony an application for a.permft, and work Is not to ataR without a pe[mit;that the work will be in
1 accordance:witt�:tfie,appYoved plari in the case of work.which requires a roview and approval of pl na.
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