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3871 Dolomite DrCITY' OF EAGAN WATER SERVICE PERMIT 3795 Pilot Knob Rood 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• Ordinances. Misc. Charges• Total • By ./� Dote Paid: Date of Insp.: 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 1 agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit• Permit Fee. Surchorge• By Misc. Charges. Date of Insp.: Total. 1 Insp.: Date Paid. All' City ol8atau Date: 3830 Pilot Knob Road Eagan MN 56122 Phone: (651) 67545675 Fax: (651) 6764684 Use BLUE or BLACK Ink For Office rise Permit V Permit Fee: Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Site Address• 38L9, 3 r71, 6 8 7 3, 3 75" ppl. o M' T' 2. Unit #: Reildetttl Owner Name: e4 46 `~ /1'1».3 4 6 t Nt E N ..•� •�: C. , Phone: 76 3-S-71— 97743 � Address / City / zip: :SO Q C Ce4 ry 2 Av, j , 1 A aoaD £.s 14 L _y 7 Applicant is: Owner ,Contractor Type oMork, Contractor Deacription of work: { i o ' €- aw RE PS. 6/ J 6 a P.4'4 Al z 7-4 I. - Construction Cost / 9,00o• CIL_ Multi -Family Building: (Yes / No Company: a £ I £,r r a 2 /%7ih.JT . Cv cep Contact: DA ✓ r 9 a�2ai S Address: 5/0 �' W (a 1 /1- J7 - State: /''? SS'y// City MPLS Phone: lo/z- S'6/-1. 2y'3 License#: '4 C- 4' / 3 / Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional inf enation) FLSIvS- g�Il'r PoS:' JS7r COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit fora 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: NOM; �y'` �� •,iiiowsedio tftaistonit CALL BFrPORE YOU 019, Cat Gopher State Ono Catl of (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.aoaherstateontacaLtpt I hereby acknowledge that this Intonnation Is complete and aoxtrate; that the work will be corifomtance with the ordinances and coda of dhe City of Bacon: tat I undeatand this is nota permit. but only en application for a pent, and work is not to start without a permit: that Mie wont WII$ be in accordance with the approved plan in the case or work which requires a review and approval of plane. Exterior work authorized by a building permit issued In accordance with the Minnesota Stam Build nflCode must be completed v/811111180 days of permit issuance. xI ',2...Q_' Applicant's Printed Name ZO/Z0 3Jbd Applicant's Signature Page 1of3 1NIVW 1X3 ISS L9Z9t98Z19 LO:ZZ bTOZ/9Z/Z0 CllyofEagall 3830 Pilot Knob Road Eagan MN 36122 Phone: (661) 676-6675 Fax: (661) 675-6684 Use BLUE or BLACK Ink For Office Use 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: • I— S — /I/ Site Address: 384 y, 3 7 '7 /, 3V73, 3 87? Qo La 141r rE A iL . Unit #: Name: -J 1@r, , Address / City / Zip: VS—c. C. a r4 ry Q Air rt.) 'a` Z A oL E•.J L4KL£lr' -sr4.th Applicant is: Owner ,K Contractor Description of work: 7— EA -2 0%1-1 a• I2 E - Paor- , Cost 13 7 o'O- Cr° Multi -Family Building: (Yes � / No ) Company. 41E I Sic 'r'c a'ode 0/47.417. emeP Contact J Avrd fld� RR S Address: 4/0 s tt.) 6 , City: _ m PG $ . State: /X1oci Zip: Sri,✓ 5' Phone: !o'Z r6/^ 6 z ya License ft. 4 C z N 1/ 3/ Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for addition& information) tos Eta L. 14arLr Pos; 197 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 _Io If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor. Phone: Phone: Sewer & Water Contractor: CALL BEFORE YpU DI(. CaU 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. 1yww.000heratateonerall.orq I hereby acknowedge 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 1s not a permit, but only an application for a permit, and work is not to start without a permit; that the work %dU be In accordance with the approve° plan In the one of %writ which requires 8 review and approval of plans. Exterior work authorized by a building permit Issued In accordance with the Minnesota State Buflth Code must be completed within 180 days of permit isauance. x btiivra Qui RAlS Applicants Printed Name 80/TO 39Vd 1NIt7W 1X3 I3fi x Applicant's Signature Page 1 of 3 L9Z9T98Z19 LO:OT tTOZ/80/I0 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA158170 Date Issued:09/30/2019 Permit Category:ePermit Site Address: 3871 Dolomite Dr Lot:18 Block: 01 Addition: Briar Hill 3rd PID:10-14992-01-180 Use: Description: Sub Type:Residential Work Type:Replace Description:Standard 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. 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 - Geraldine A Dodge 3871 Dolomite Dr Eagan MN 55122 (651) 274-6943 Champion Plumbing 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365-1340 Applicant/Permitee: Signature Issued By: Signature