4243 Blackhawk Rd CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.•
Eagan, MN 55121 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:
B S - Date Paid:
Date of Insp.- 4 Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3830.Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Dote of Insp.: Total:
Insp.• Date Paid:
Use BLUE or BLACK Ink
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3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 1 I
Fax:(651)675-5694 I Staff: I
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2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ��Sr�� Site Address: ��`'� � ���i� /7D;w� Q� Unit#:
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� � License#: Y�- ��g�Z� Lead Certificate#:
If the project is exempt from lead certification, please explain why:
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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:
Fire Suppression Contractor: Phone:
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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.ora
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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App lican Ys Prin t e d Name ApplicanYs Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA171472
Date Issued:08/18/2021
Permit Category:ePermit
Site Address: 4243 Blackhawk Rd
Lot:011 Block: 07 Addition: Sun Cliff 1st
PID:10-72975-07-011
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 & Victorine Hinrichs
4243 Blackhawk Rd
Eagan MN 55122--221
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature