1642 Donald CtCITY OF EAGAN
3795 PiIdt 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:
1 agree to comply with the City of Eagan Surcharge:
WATER SERVICE PERMIT
Ordinances.
By
Date of Insp.:
1r
Misc. Charges•
Total •
Dote Paid:
I nsp •
CITY OF EAGAN
3795 Pilot Knob Rood
Eagan, MN 55122
Zoning: --
Owner:
Address: ---
Site Address:
Plumber: _—_---
SEWER SERVICE PERMIT
PERMIT NO.: ---
DATE:
No. of Units:
agree to comply with the City of Eagan Connection Charge: --
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By
Misc. Charges:
—
Date of Insp.. — ---- --- Total:
Insp.:
Date Paid:
41/1".
ty of Eta]
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
1
For Office Use
Permit #: 119.g]
�
Staff:
2013 RESIDENTIAL PLUMBING�PERMIT APPLICATION
Date: - 1 Site Address: 11 /
9 - )cmm i .f 7 C
Tenant:
Suite #:
Reel fent/Owner
Name: r)C G.. \- t-71, n-- e, 0 *A Phone:
Address / City / Zip:
Contractor
n l - \ /�
Name: f t R Lc _1 lS2 LJ� �w.Y )ln� License #: (� �Ci 1 r),-,
Addressr3T
State:
\)G.ry-, .vz-.st N.; \A, S _ City: QtittOk 0 QQ✓161..P,
Zip: S fl \1G Phone: .,+1 S 1 'N*Li�c1 -C) s-- c
Contact:
( \ O.. Email '1', r 1^1% e pi ti1r��„nom ;) CtvnGe.J) , Y1.
Type of Work”
.
_ New Replacement Repair Rebuild Modify Space Work in R.O.W.
_ _ _ _
' .• k-1-9 ``wva>
Description of work: rQM Y\¢ n...�1" tn� i� c•n...P
Permit TYPe'
RESIDENTIAL
Water
Heater
Irrigation (___ RPZ /_ PVB)
System
New
Water Softener
Lawn
Plumbing Fixtures ILMain / Lower Level)
Septic
Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,
$60.00 Lawn Irrigation
$60.00 Add Plumbing
'Water Tumaround
$115.00 Septic System
Water Softener,
(includes
Fixtures,
or Water Heater and Softener
(includes $5.00 State Surcharge)
Turnaround* (includes $5.00 State Surcharge)
and $5.00 State Surcharge)
TOTAL FEES $ CII S, 00
$5.00 minimum State Surcharge)
Septic System Abandonment, Water
(add $200.00
New ($10.00
if a 5/8" meter is required)
per as built) (Includes County fee
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
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.
'l l ckt
X 1.1 y\A ; C v\
Applicant's Printed Name
Applicant's Signatu
FOR OFFICE U
uied•Ins
Related
Read
/Abk
City of Emu
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: l 2 / l3
r
Use BLUE or BLACK Ink
For Office Use
Permit #: t19551.
Permit Fee:%
Date Received: I a`' S / 13
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address: '!O `7 2 Digvlc„IOLG
Unit #:
Resident/
Owner
Type of Work
Name: pckoi _ COG, -0/4
Phone:
Address / City / Zip:
Applicant is: Owner Contractor
Description of work: -Tilt-4-c.':17r
Construction Cost: �J
Company: Rn h / leg, O eIi-i c�
Address: L d d s O Park :o I— •J
+0 h,000Se— �el'IJ�ced00 i
Multi -Family Building: (Yes )X / No )
State: CI Zip: 3 3 Phone:
Contact:
City:
6,c/— 20 , -2-17
p
License #: a L63 d 2/ r 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:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be,
the information may be classified as non public it you provide sp'eciificsreasons-
conclude that thy are -trade sec'rets.'
public information.: Portions
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; 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 x
Applicant's Printed Name Applicant's Signature
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