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4451 Lakeshore Ter Use BLUE or BLACK Ink For office Use City of EaRan Permit 02) I - 03 3830 Pilot Knob Road a R + g t';', j Permit Fee: _ _ I i=- Eagan MN 55122 Phone: (651) 675-5675 I Date Received:__ I I - I 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) ) - 7 . - 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. X 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