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2170 Water Lilly Lane
Date: City of Eaali 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use /_� 1 50'Permit #: Fee: LQD G1 Permit Fe Date Received: 11 1 9. Staff: 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION 1 t Jen= '' UN. - IJ i Site Address: Tenant: l u Suite #: RESIDENT / OWNER Name: Address / City / Zip: e.S UY1 2470 * Phone: 15`1 3� ci- CONTRACTOR Name: Appliance Connections Inc, License #: 12850 Chestnut Blvd. Address: — s opee, N 55379 City: 952-445-4803 State: Zip: Phone: Contact:\J-'' - Email: — TT9 M TYPE OF WORK New Replacement _ Repair —_ Rebuild Modify Space Work in R.O.W. Description of work: _---__—_—� PERMIT TYPE RESIDENTIAL Water Heater Lawn Irrigation, (—_ RPZ / _ PVB) Septic System New Abandonment Water Softener Add Plumbing Fixtures (___ Main / Lower Level) Water Tumaround RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $189.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Cali 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.orc 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 e case of work which requires a review and approval of plans. 0t'' t r.osif x Applicant's Printed Name Applican S gnature FOR OFFICE USE Reviewed By: Date: Required Inspections: _Under Ground ___Rough -In _Air Test _Gas Test _Final 5KA-10(6 lfir City of Eaali 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 60 For OfficeUse� (9.tPermit # Permit Fee: Date Received: Staff: 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: (.2 e211-/1/ Site Address: gr7o W -ec [l 6�y Lor e_ Tenant: 2-c C P. e MOOY) RESIDENT / OWNER Suite #: Name: t V 1�1"C {' 1' t©e Y Phone: Address / City p: ai7o t.)ci-4e (,ily t T -- 6`312 _."2 / Zi Applicant is: Owner X Contractor TYPE OF WORK Description of work: &It/2 fi 6 pp RePt fe-iE e�C...e/ Multi -Family Building: (Yes / No Construction Cost: CONTRACTOR Name: ere, f Fy, /C,'-/ fir' GLZ License #: Z/�� Address: '0' 2-392 C >pf ' /e City: GGf ?7J,1? /4»-? State: MA/ Zip: .46Gi3 Phone: ZP5f a'i) C,/ ei Contact Person: / 54�29eQ 1/.5 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 Minnesota Rules 7672 Energy Code . Residential Ventilation Category 1 Worksheet New Energy Code Worksheet Category Submitted Submitted (11 submission type) e Energy Envelope Calculations Submitted 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: Phone: Sewer & Water Contractor: NOTE: Plans and supporting documents; thatyoaSubthit are considered to be public information. Portions of the information may be classified as non -public -f you provide specific reasons that would permit the City to conclude fhatthey areitiade.secr,ets.` 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 GDT/ /tFGi'nZ Applicants Printed Name x Applicant's Signature �►•�/Aoi Page 1 of 3