4696 Lenore Lane Orr., liteAti
WAT R SERVICE '
' ? Kser Reed PERMIT P40 -"
r .
,i.r,; 4122 (WE: r /10/C
z on i ng: RI II . - No. of Units: 1 unit trthse
(Artier: Orrin Thhoipson Horace
Site Adt : 4696 Lenora Lane L4 B13 11 .dzec1 f e IV
plumber: Benz
Mier No.• I CjonnoctioQ+ s: 335.00 pd
Size: .; Account Deposit:
Reader No.: Permit Fee: 0.00 pd
1 sate! its esepiir with the City of $S Savarge: .50 nd
Misc. charges 60.00 pd reter
,� Total:
ey - 4. 4 ` i% Dots Paid:
D of t �' " 3J � Insp.:
an , O ImAt , Seiket SMt
_ PERMIT too.: 4s' f
=lel 22 DATE *-7:711T} i
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Ste �4dd : , ', '=' Ierore Lane 74.713 7 'i , '' - eel P7
plumber: e'en r 7 'yar:
3/:741,7,1 ^ ^t '
�;F7 10 ,. , j h ,,
#.410.0.6)soriply wail. the of ilogoo Connection Ctwrge: 4' c _ a'- ",-_
Account Deposit: 3.
Permit Fee: .. - 10.0 0 = ....
' -. Surcharge: .. f rd
By — Misc. amnia
` _ Total:
1
a . once
Use BLUE or BLACK Ink
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3830 Pilot Knob Road i; � � 3 �
Eagan MN 55122 �'. w ��� ��° � Date Received: �� � ��-
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Phone: (651)675-5675 .s';;..___,__.��.- __ _. � �
Fax: (657)675-5694 I Staff: , _ � i
�---------------
2014 RESIDENTIAL PLUMBING PERMIT APPLICATION I
Date: a I 1 Si 1� Site Address: �'�'�n 9(n L e�o�� l.._IV I'�,
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Tenant• Suite#:
� � � �� Name: �oha(� M G�+n , Phone: �05�- �S�- �7.$��, � �
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Address/City/Zip:_ � �o�l�p ��tnC�l/'� �--�
� f Name: � t,� ' License#: IL �ra�3 � S�
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�������, � Address, r�a� �,6'lx.vti'� �� U� City: �55��t�
' State: Y `�� Zip: :.TJ 3�,cj Phone: �9 5� ' �'S�- �U I �
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' Contact: EmaiL• � f �r ,�{
� ��� _New �Replacement _Repair _Rebuild _Modify Space _Work in R.O.W.
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` � �, Descriptionofwork: U �-�� (/�-�Ci`�'�
� � �;, RESIDENTIAL
�
� � Water Heater
� ' ` Lawn Irri ation Water Softener
���,�,�� 9 (—RPZ/_PVB)
�r
Septic System Add Plumbing Fixtures�Main/_Lower Level)
� New Water Turnaround
� � � Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,Water Softener, or Water Heater and Softener(includes$5.00 State Surcharge)
$60.00 Lawn Irrigation(includes$5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic Svstem Abandonment,Water Turnaround*(includes$5.00 State Surcharge)
*Water Turnaround(add$200.00 if a 5/8"meter is required)
$115.00 Septic SVStem New($10.00 per as built)(includes County fee and$5.00 State Surcharge) pv
TOTAL FEES$ GJ D '
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.orq
I hereby acknowledge that this information is complete and accurate;that the work will be in confortnance 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.
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Applicant's Printed Name Applicant's Signature
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PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA142178
Date Issued:04/18/2017
Permit Category:ePermit
Site Address: 4696 Lenore Lane
Lot:4 Block: 13 Addition: Ridgecliffe 4th
PID:10-63983-13-040
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
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.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 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 -
Ronald G Mans
4696 Lenore Lane
Eagan MN 55122
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature