1515B Clemson DrCITY OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO •
lagan, MN 55122 DATE•
Zoning: No. of Units•
Owner:
Address•
Site Address•
Plumber•
Meter No.: Connection Charge•
Size: Account Deposit•
Reader No.: Permit Fee•
1 agree to comply with the City of Eagan Surcharge•
Ordinances.
By
Date orInsp.:
Misc. Charges:
Total •
Dote Paid
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:
By
Surcharge
y Misc. Charges:
Dote of Insp.: Total.
Insp.: Date Paid.
15�5P , 15l55, \5f A 611 '6 CA5On 1) -r -
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #:
11381a
Permit Fee: • 1 S
Date Received:
Staff: 0 V
/C1
Cil-, i )S -13-1517_75_T7 8
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 4\u10
Site Address: i �) C 1 DDV mS O Prc V t Unit #:
Name: I i' I OM 1 t t/ 1xs li OW Q
r� n JS GfO lPhone:
tol uK S we i, o
OWner Address/City/Zip: 1
—✓`1 Q I 2, .-7o8 74Resident/CQ/�VVYCn V }2)✓)CUI
01? 1 l2
J
Applicant is: Owner
Contractor
Type of Work
Contractor
Description of work: T€rti VVff wad tri l V Ot Vtio vt G a c'i"I �&
Construction Cost: Pj Ca 00
Multi -Family Building: (Yes X / No -
Company: $Ql a Tll 1 V0.,'tcQ Qeevriir%El,ni tact:
Address: t-%I(j(� ,{x_c�1s/c,� P3iUS City: Acy- k.
State: (Yl h Zip: S61I /6 -
Phone: 96--a- cl is- 7aik .to
License #: 0-4Z-001 U �b Lead Certificate #: / `i 9 ` ' SG' 3L( -
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.aopherstateonecall.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.
120A, I Vl wSS
Applicant's Printed Name App ' .. is ature
Page 1 of 3
City of Eaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
/39q�c
7.6)430
Permit #:
Permit Fee:
Date Received:
Staff:
2015)RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 107-5 / Site Address: / 5 / 5 - C/ i4' )//,e -
Suite #:
Tenant (A li ( Are->
Name: CCl/el. Id re ,-)1,(,9,e...„ Phone: / " b 2-3515
E h f4 s I �--
Address / City / Zip: 1515.:_ 13
Name:
Address:
State:
Contact:
v' V'C� �AA Y� ✓ iC�
Zjip: 5o'l
New _ Replacement
Description of work:
License #: G;'
City: !4U)'
Phone: �S3
Email:
_ Repair
_ Rebuild Modify Space _ Work in R.O.W.
RESIDENTIAL
Water Heater
Lawn Irrigation ( RPZ / PVB)
Septic System
New
Abandonment
Water Softener
Add Plumbing Fixtures ( Main / _ Lower Level)
Water Turnaround
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener (includes State Surcharge)
$60.00 Lawn Irrigation (includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes State Surcharge)
*Water Turnaround (add $280.00 if a 3/4" meter is required)
$115.00 Septic System New (includes County fee and State Surcharge)
TOTAL FEES $
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; tat the work v51 -be in
accordance with the approved plan in the case of work which requires a review and approval of plans. o
Applicant's Printed Name
x
Applicant's Signature
EAGAN
3830 PILOT KNOB ROAD 1 EAGAN, MN 55122-1810
(651) 675-56751 TDD: (651) 454-8535 1 FAX: (651) 675-5694
buildinginspectionsC cityofeagan.com
tCI
For Office Use /_
Permit #: /,•
rt[�
Permit Fee:
47:b
Date Received: / 6 - "(` i g
Staff:
L
2018 RESIDENTIAL PLUMBING PERMIT APPLICATION
•
Date: / / 1• l b Site Address: /S. /S f C ler
d1vs,
J
Tenant: �`'t Q �) +0 4 1 i `c v -• ( Suite #:
Name: (,erg
P& Phone: (, .r'' (a
Address / City / Zip: / 5 i 5 iS C /e r�
Name: oess;en p),.‘,„40.3,_Fe ,;c, License#: `') TC-- yyjS&
Address: P C 40 )c 02/ 7 City: -$c'r
State: ("A' Zip: S S/ 2 2 Phone: (, S/ C. 81 cF 2-5 Z
Contact: IM ; Email: e
6,7A. . C«. -s.•
New placement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Description of work:
RESIDENTIAL
1--9 er Heater
Lawn Irrigation ( RPZ / _ PVB)
Septic System
Abandonment
Water Softener
Add Plumbing Fixtures ( Main / _ Lower Level)
Water Tumaround
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener (includes State Surcharge)
$60.00 Lawn Irrigation (includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes State Surcharge)
*Water Tumaround (add $280.00 if a 3/4" meter is required)
$1 15.00 Septic System New (includes County fee and State Surcharge) TOTAL FEES $
0 Ov
CALL BEFORE YOU DIG. Call Gopher State One CaII 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
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeagan.com/subscribe.
1 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.
;14-k_ f'c. ), i ) `tL
Applicant's Printed Name
X r
Applicant's Signature