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3254 Dodd Lane VILLAGE 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: I agree to comply with the Village of Eogan Surcharge: Ordinances. Misc. Charges: Total: By Date Paid: Date of Insp.: Insp.: VILLAGE OF EAGAN SEWER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber: I agree to comply with the Village of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: Surcharge: By: Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: Use BLUE or BLACK Ink j For Office Use 1 Iz~~ ►~1 City of Eajan ; Permit Permit Fee: I 3830 Pilot Knob Road l I Eagan MN 55122 Date Received: 1 l 1 Phone: (651) 675-5675 ; Staff: ; Fax: (651) 675-5694 2014 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: site Address: 325' W~ LeL~'= sy/ Z l Tenant: Suite Resident/Owner Name: )I 0_U LL) e- e!1 ~e_L~ Phone: ~,~I -33-5-- Address l City 1 Zip:_52-~_q D J_znr_ cp ST-121' Name: License Contractor Address: City: State: Zip: Phone: Contact: Email: Type of Work - New Replacement _ Repair _ Rebuild - Modify Space Work in R.O.W. Description of work: !uL" t54fl✓~ _VcL'l'(. Ec~ L.)j Th T6klti( RESIDENTIAL J Water Heater Lawn Irrigation RPZ / _ PVB) Water Softener Permit Type 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 System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $200.00 if a 518" meter is required) $115.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ b 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.go2herstateonecall.org 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. x n x Applicant' Printed Name Appl n s Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final Meter Related Items: Meter Size Radio Read Staff: Use BLUE or BLACK Ink I For Office Use I j I City of Eap Permit#. I Permit Fee: v J 3830 Pilot Knob Road Eagan MN 55122 j Date Received: Phone: (651) 675.5675 1 1 Fax: (651) 675-5694 I Staff: I I I 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 19 - I I Site Address: M L Unit Name: -3a Phone:157 -33-5--2xtl Resident/ 2 cam, / / Owner Address /City / Zip; Li macaw r.J1 A Applicant is: Zomer Contractor I_ reDlar-P -W .1 'D s L) -SWMe S) 72 P1 6I Type of Work Description of work: 1 Construction Cost: J gn- Ia ~S Multi-Family Building: (Yes No ) Company: Contact: Contractor Address: City: State: Zip: Phone: Email License 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: 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 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.oooherstateonecall.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. Lo eiA~(Z A6~ x Applicants Printed Name App a s Signature Page 1 of 3