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1243 Timbershore Lanecc fro City olBaQan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 39q)-7-o Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: 62 0 crb Date Received: Or 'QC 13 Staff:,- n 11 (2013 RESIDENTIAL PLUMBING PERMIT /APPLICATION Dater d ()- 13 Site Address: / 4 !0 / 11i%cre_, Lc Tenant: Suite #: ResiitentlOwner Name: t.fC flOnorm Phone: ON - 339-- 3 Ad 1 l dress / City / Zip: k9 3 iTin Orr. Lam, , = = == -font rapt or: =`: -_' __ --- _ = - _ _ -- Name: ��o0n n�wi�aan� uc License t/: PC 0157 O3 diva Benjamin Franklin Plumbing Address: 142-13rd St K City: t�I:n.t.pIw.MK55x11 1 pp State: Zip: Phone: �01� • Dk7`C:t'� Contact `It1 I AM ' ! Email : i, 1 - le I © CAE i 1 ..u61 s = -= == pe of Work,._ _ - —_. ,_ _ - -- _ - :. ` _ New �. eptacement Repair Rebuild Modify Space Work in R.O.W. _ Description of work: , _ _ kA ~ii 1t-! 1 • - Permit_ Type _ - = - - ( RESIDENTIAL Water Floater Softener _ Lawn Irrigation ( RPZ / AVB)ater Add Plumbing Fixtures ( Main / Lower Level) _ Septic System New Abandonment Water Turnaround RESIDENT(AL FEES: $60.00 Water Heater, $60.00 Lawn Irrigation $60.00 Add Plumbing 'Water Turnaround $105.00 Septic System Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) Turnaround` (includes $5.00 State Surcharge) and $5.00 State Surcharge) TOTAL FEES $ (indudes $5.00 minimum Slate Surcharge) Fixtures, Septic System Abandonment Water. (add $200.00 if a 518" meter is required) New ($10.00 per as built) (includes County fee 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.vopherstateonecall.orq I hereby acknowledge that this information is complete and accurale; that the work vall be in conformance with the ordinances and codes of the City of Eagan; that I understand this Is nor 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 approve of plans. x ��t lJh 5mi Th Applicant's Printed Name :FOR-OFFICE USE ;Required Inspections: n ._o(rN Jul 28 2014 09:49AM HP FaxGates G.C. 7634987710 page 14 Use BLUE or BLACK Ink � ForOHieeUse---------� �it of Eao� ; Pertnitit ! ��� / I b � Pertnil Fae: � (_� � 3630 Pilot ob Road �-7 Eaga�MN 122 � Date Received: l * � Phone:(65 �675�5675 I I Fax:(B51) 55694 � Staff: I I I �����������������J ; o�a RESiDENTIAL BUiLDING PERnnir aP��icarioN '' �Y' 'u� /?3 �I ; 7 4'. �i� y' �j ' 7 L% �` ``rM/`i!.v�:�"^°' �./'� Oate: • � SiteAddress: -' � ' � ` � •� � Unit#: �._.,.,.,,...._,...., ._......._lj..�..,..�...� ,' `T,..,....�.W......w... ��....__ � Name: �'I'LlSfi�'..�izC��� r';�ll�, Phone: ��;�,�,;✓� �J!?:', � Resident/ Owner Address I City/Zip: ;�Ct� �b�! ' Applicant is: Owner '� Contractor ,,.,,..�..._. .._........_.._. � - �.._w,.�,,,�.._..._:.e.. _._........ .._._.__M�.�.�.._.,._.,,,...._- ---�--------- r ,. � � � _--_. Type of Work �scription ofwork: ' `-�'" �,� ��"l�"� � rr ✓�j J:. Construction Cost: � �� � Mulli-Family Building:(Yes '� /No� Company: 7�G°" � ,,�iu� �� �,r<!%1%Y Contact: /%/�.� •'-z-� � COf1t�21Ct0� Address: 3, 7'_' :/:,i�j�"'u'N �:/�'f 1`'"� Cily: �i%lilsn:,vi__ '. -'r c. � � �7 � /�', i r . / � state� I�f 1 zip: SS';:�:! Phone: {�=- �s-'� ..; Ema iL• ��s�:�2.;• � ���:iP,•�+�'•a!=�''� _'.:;e-..�. � �'r- ��,�p y q� ' �{l�' 'f L";: y_� ., ' � Licenae#: Lead CertificaLe#: / If�the project is ex pt frorn lead certification, please explain why: (see Page 3 for additional information) ' � ----- ______...._...... _..._...._._.. ....,,...,._. � COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING ~ Y � � In the last 12 mont ,has the City of Eagan Issued a permit for a similar plan based on a mastor plan7 �� _Yes _No I yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contra or: Phone: Sewer&Water Con actor: Phone: NOTE:Plans an supportlnq documents that you submit are considered to be public infarmafion. Portions of the informatior� ay 6e c/assified as non public if you provide speclifc reasons thaf would permif the City te °` _.,,_,,,,,__,__, � � ��conclude that fhey are trade secreis. �_�..�,.V � _,.... .__..._..__ CALL BEFORE Y DIG. Can Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours Detore you intend to dig receive locates of underground utilities. www.000herstateonecall.ora I hereby adcnowledge t this information is oomplete and accurate;thal the work will be in confortnance with the ordinances and cades of the Cily of Eagan;that I undersla this is not a permil, but only an application for a pertnit, and woric is nol to slart wilhout a permit Ihat the wartc will be in accordance wilh the app ved plan in the case of work which requires a review and approval of plans. Exteriorwork a by a building permlt Issued in accordance wilh fhe Minne Sta Building Code must complotad wlthln�80 days of i nc . x �''ti"�� x Appllcant's mte�i ame Ap i s Signature Page 1 of 3