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City of EaK an Permit
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3830 Pilot Knob Road Permit Fee:
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Eagan MN 55122 1
Phone: (651) 675-5675 1 Date Received: Ind k 1113, ~
Fax: (651) 675-5694 1
Staff: n^f)
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2013 COMMERCIAL BUILDING PERMIT APPLICATION (1o
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Date: C~1 12-7/ t3 Site Address: G~(OJ' 4 _ ~1Z31~rzS~ y►zilyl~g ~J~ t~4~O~{ G`_
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Tenant Name: Q~ F~th (QMft5 komtajenant is: New / X, Existing) Suite
Former Tenant: Q
Name:D 4.0m\oAs a, SAW-1 OtAl %!?Kr n I,MS Phone: 4 3;L- 81 7 9
Property Owner Address/ City /zip: RD Do)( 5 C1C3eh0Jv4 MAI 5'S b$
Applicant is: Owner Contractor
Type of Work Description of work ► Cc~t' d ic~ - Coy~ GK C1„nit 5 a . ~h Ct C-
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Construction Cost: 5 S 1 b 3 3 1
Name: O " C ov\.~ (-%xC -i a License lJ 22,11-1:L
Address: IL L IL C `ojv\dt omic - City: I05L MOJvl T'
i Contractor 4
State: Zip: T50(69 Phone: GPI " 2 1(.5
Contact: Email: ~Lut ~d ~e~~tC~ 0~5. Ca•o~'1
Name: Registration
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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 that they are trade secrets.
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.goi)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 requires a review and approval of plans.
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Applicant's Printed N We Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA161251
Date Issued:05/14/2020
Permit Category:ePermit
Site Address: 4123 Ruby Lane
Lot:080 Block: 04 Addition: Diffley Commons 2nd
PID:10-20451-04-080
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater & Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Teresa E Vandergrill
4123 Ruby Lane
Eagan MN 55122
Metro Heating & Cooling
1220 Cope Ave E
St. Paul MN 55109
(651) 294-7798
Applicant/Permitee: Signature Issued By: Signature