4196 Running Brook Rd
41 VA r 91 &6 ,,4 Vb& A V10 Use 3LIalE or BLACK Ink
41cl21 'Im4i .4 ~UlV1V11 i
I For Office Use
I I
" I Permit , I LS Oi
I I
- Coly of Eap
I Pug I
I Permit Fee: ~ Pug • ~ ~ ~ /
3830 Pilot Knob Road I I
Eagan VIN 55122 j Date Received: 5
Phone: (651) 675-5675 I I oZ !
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Fax: (651) 675-5694 j Staff: U~~ I
t-----------------I
013 COMMERCIAL BUILDING PERMIT LI i H
Date: Site address:t qb I
Tenant Name: (Tenant is: New / Existing) Suite
Former Tenant:
E
Name: Phone:
Property Owner Address / City / Zip:
Applicant is: Owner Contractor
i~ g-
Type of OL Description of work: Re-
Construction Cost:
Name: License
;tor Address: -=-City: --'C.
State: Phone:
Contact: Email:
Name: Registration
Architect/Engineer Address: City:
State: Zip: Phone:
Contact Person: Email:
Licensed plumber installing new sewer/water service: Phone
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude thEt~ they are trade secrets.
BALL 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.gol)herstateonecall.org
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 rewires a xeview and approval of plans.
Applicant's Printed Name Ap t cant's SicU. nature
Page 1 of 3
Use BLUE or BLACK Ink
�--------
---------�
� For Office Use �
I '`�^"���� �
Clt� of �a��Il � Permit#: � �
, a'w �
I Permit Fee: �
3830 Pilot Knob Road i I i
Eagan MN 55122 � Date Received: � 1 �
Phone: (651) 675-5675 � i
I Staff:
Fax: (651)675-5694 �________ ________�
2014 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: � /��(Z!�1�- Site Address: �"��Q� Wrrw�ir�a 1�Lc._ �
Tenant: Suite#:
Name:��sle��s ��ys Phone: �CnS11 2.�0--4-24-�
�+�id� r��� , �—
Address/City/Zip:
Name: /�',r�v��sc7�to._. v...��ery �luv,.�►nm License#: ��9��
�������, Address: �O�'4t� Lvr,.��,�_ /�,,,� S Svtiu. jB�City: �l�a rn.c�n
State: M:al Zip: S�SN'2U Phone:��SZ 1 t��� '" Z��'Z
Contact:�lZ� 3°8� -24�3 EmaiL v'
.������� _New �placement _Repair _Rebuild _Modify Space _Work in R.O.W.
;
° Description of work:
'' RESIDENTIAL
' Water Heater
Water Softener
Lawn Irrigation(_RPZ/_PVB)
'�������� Add Plumbing Fixtures(_Main/_Lower Level)
Septic System
_New Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,Water Softener, or Water Heater and Softener(includes�5.00 State Surcharge)
$60.00 Lawn Irrigation(includes$5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Turnaround*(includes$5.00 State Surcharge)
*Water Turnaround(add$200.00 if a 5/8"meter is required)
$115.00 Septic System New($10.00 per as built)(includes County fee and$5.00 State Surcharge) �
TOTAL FEES$ ��.
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
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.
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Applicant's Printed Name A ant's Signa
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