4141 Ruby Lane
Use BLUE or BLACK Ink
JAI
I For Office Use
Permit#: k-1S of I Permit Fee: 1E2~
City Ea~d
3830 Pilot Knob Road I
Eagan MN 55122 t
Phone: (651) 675-5675 i Date Received: 1 3
Fax: (651) 675-5694 j Staff: I
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2013 COMMERCIAL BUILDING ERMIT APPLICATION S u.~ I
Date: 1 27 1-75 Site Address: YGIV
Tenant Name: 0-,,VR j convoy", a.~►\\S ®4,.~ ~ar~cn kor&'*(Tenant is: -New/ Existing) Suite
Former Tenant: Q
Name: ~tN Z.oeUne. S V~~~a.5 w~~ d1aC~,n IwncS Phone: lJo- 4 3 a• 87
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Property Owner Address / City / Zip: P~~ok J N>3e_ o n~ n m 5,5-0 (0
Applicant is: Owner Contractor
Description of work ~GwC O~F on-\C- Govt GK~► 5"A1^h Ct~ai~
Type of Work Construction Cost- 155 1 3 11
Name: O ~ (_0V%5. ('QC1i o License V5 L Z2 t a
Contractor Address: kouvtd{ lc_ ayL City: 1~5L ~yJ~'1 T
State: M 1 Zip: J~t~( Q Phone:G S- I" 2 k;L
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Contact: LC4. 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 that they are trade secrets.
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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.aopherstateonecall.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:EA177715
Date Issued:07/14/2022
Permit Category:ePermit
Site Address: 4141 Ruby Lane
Lot:073 Block: 04 Addition: Diffley Commons 2nd
PID:10-20451-04-073
Use:
Description:
Sub Type:Water Heater
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 -
Debra M Hipp
4141 Ruby Ln
Eagan MN 55122--216
(651) 303-9190
Champion Plumbing Llc
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature