1538B Clemson Dr CITY OF EAGAN WATER SERVICE PERMIT
3830 PiI+a Knob Road
P.O. Box 21199 PERMIT NO.:
En an, MN 55121 DATE:
Zoning: No. of Units:
Owner: ice,
Address:
Site Addess: 1 1 ewson Drive R rd
Plumber: T —
Meter No.: Connection Charge: —
Size: - Account Deposit:
Reader No.: Permit Fee:
I agree to comply with the City of Eagan Surcharge:
Ordinances. / Misc. Charges:
By pn —
� GJ/ ( U /' ) Total:
Date Paid: t ez
Date of Insp.: /Q ��f' 24° / insp..
CITY OF EAGAN
3830 Pilot Knob Road SEWER SERVICE PERMIT
P .O.! 3 oz21199
Eagan, MN 55121 PERMIT NO.:
Zoning: DATE:
Owner: No. of U nits:
Address:
Site Address:
Plumber:
1 spree to comply wDf. Hoe City of
Ordinances, Ea9Op Connection Charger
Account Deposit:
Permit Fee:
By Surcharge:
Dote of Insp.: Misr• Chorges:
Insp.: Totol:
Date Paid:
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Use BLUE or BLACK Ink
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of Eap Permit ~ U~l
I Permit Fee: S 1 • 1
3830 Pilot Knob Road I I
Eagan MN 55122 j Date Received: I t) j
Phone: (651) 675-5675 1 I
Fax: (651) 675-5694 1 Staff: I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: - k l - 13 L8 t5 '843 ) S d 5 b (hJ~?'~
Site Address: Unit:
Name:'~r T~l✓ri ~i -_Phone: -Z• 72f- _S S-ad
Residentf
:Owner Address / City / Zip: _
Applicant is: Owner Contractor
Typeof Work. Description of work: QF r1
' - - -
Construction Cost: L- 11 (:0% 5 Multi-Family Building: (Yes _ / No
Company: W'q C7 ./75_Lr Contact:
Address: ~Q ; nne-h Aa- --_v__ City: M in nea4 1 s
Contractor ~
State: AJ Zip: _ 5'5 0 Phone:
-41
License ..sr_ 19 10 6 2- Lead Certificate ~ = 2 !Y2,7'7
- l
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 ff 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) 4540002 for protection against underground utility damage. Cali 48 hours
before you intend to dig to rive locates of underground utilities. www.Q29INDrstateoneoa11.251
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.
x~l(z0.bei Cr-2vten x_
Applicant's Printed Name ApplicanjKs Signature C/
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA118061
Date Issued:10/28/2013
Permit Category:ePermit
Site Address: 1538 Clemson Dr B
Lot:2 Block: 01 Addition: Thomas Lake Heights 2nd
PID:10-75951-01-020
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.
Kris Oien
3670 Dodd Rd
Eagan, MN 55123
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 -
Larry A Horton
1538 Clemson Dr B
Eagan MN 55122
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature