4451 Lakeshore Ter
Use BLUE or BLACK Ink
For office Use
City of EaRan Permit 02)
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03
3830 Pilot Knob Road a R + g t';', j Permit Fee: _
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Eagan MN 55122
Phone: (651) 675-5675 I Date Received:__ I
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Fax: (651) 675-5694 Staff
2013 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 2o
Site Address:
Tenant:
_ Suite
Resident/Owner Name
Phone: 1321--2311
Address / City /Zip:
Name: _ i
License
Address: Appliance Connections Inc. City:
Contractor
A
hakopee, MN 553X~ne:
Stateaj:1
-ContEmail:
fi Type of Work New Replacement Repair -Rebuild
- Modify Space -Work in R.O.W.
s _
I Description of work:
RESIDENTIAL
3
~ # J- Water Heater
I
Lawn Irrigation Water Softener
Permit Type RPZ / PVB)
Septic System Add Plumbing Fixtures Main / Lower Level) r
New Water Turnaround
t # - Abandonment
RESIDENTIAL FEES:
$60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surchar e
$60.00 Lawn Irrigation (includes $5.00 State Surcharge) g )
$60.00 Add Plumbing Fixtures, Seotic Svstem Abandonment, Water Turnaround* (includes $5.00 State Surchar e
`Water Turnaround (add $200.00 if a 5/8" meter is required) g)
$105.00 Septic Svstem New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) )
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TOTAL FEES
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.org
1 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, a d work is not kture
without ape 't; that the work will be in
acc Lrdaneith the ap roved plan in the case of work which requires a review and ap royal of plans.
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1XI ~2
Applicant's Print d Na Applicant's Sig
FO
R OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-in Air Test _ Gas Test -Final