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4682 Lista PtCITY 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: Misc. Charges: Total • Date Paid: of Insp.: /° /_5 Insp • Ordinances. / c Date f CITY OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 Zoning: Owner: Address: SEWER SERVICE PERMIT PERMIT NO.: DATE: No. of Units: Site Address: Plumber: I 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: leitt° C!ty of Earn 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: !1 ?v1 3 Site Address: %'%? I419% flUTO 1 yL1t,yLFo GSA Pt- Unit #: Name: 21d'l°Ci-f 5 Phone: Address / City / Zip: Applicant is: Owner Contractor Description of work: --f-/O �� "' re.)L Construction Co zy o v Multi -Family Building: (Yes / No ) Company: -6,212C kt Prikt-'e /+-t P Contact:.L�e N. Address: I LIDS-gleirTle-s' Ot State: Zip: cf3 ?7Phone: License #:3 FU C4.7 city: I ieNCI4.1Cp 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: Phone: Sewer & Water Contractor: Phone: Mechanical Contractor: NOTE:`Plans and supporting documents ilia the information may be classified as non -pi ►bmit are considered to be public information. ou provide specific reasons that'%rould perinif tiey 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.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 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. Pi Applican s Printed Name x Appli s Sig ure Page 1 of 3 41° City of Eapi 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: V-"" 7 --(/ Site Address: 14 7,gL8'% Ihniteri y17F %412 664 i" Unit #: Resident/ Owner Name: IID 6 e (L /Fre (c t Phone: �J� Address / City / Zip: L_ it41 Applicant is: Owner Contractor T e Of Work yp Description of work: -5/07115 Construction Cost: 0 , (,L;(� Multi -Family Building: (Yes X / No ) Contractor Company: 0/e/ZC1d'I /-7 4 C'. "1i/ Contact: A `�'1 G-- 41.567V -e "ii P Y� / Address: / 30Q Gs .0/ / e� Gt' City: ge.J/LL1.54/7(! "t' f/° State: f � Zip: Sr S— 7 Phone: U!/®1 — F/ t "- 7 P U X33 License #:42 v / 3 ko G G Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, _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: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: NOTE: Plansand 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 the 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.gooherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codeeof 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 ork 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 complete within 180 days of permit issuance. / y e J''� '/fort x � .rF` A Printed Nafiew PP Ap'. cant's gnature Page 1 of 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA160690 Date Issued:04/03/2020 Permit Category:ePermit Site Address: 4682 Lista Pt Lot:4 Block: 03 Addition: Ridgecliffe 3rd PID:10-63982-03-040 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. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). 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 - Matthew Kelley 4682 Lista Pt Eagan MN 55122 (651) 346-8500 Milbert Company (culligan) 1801 50th St E Inver Grove Heights MN 55077 (651) 451-2241 Applicant/Permitee: Signature Issued By: Signature