1844 Cliff Lake Ct
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~~lVl Permit
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City of Ealan I Permit Fee:
1
CT162013 1
3830 Pilot Knob Road 0 1
Date Rec ived:
Eagan MN 55122 ~I
Phone: (651) 675-5675 I staff.
Fax: (651) 675-5694 L---------------- -
2013 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date:, I - Sfte Address: ~r l fi`t' ~~A
Tenant. Sl~~`~ ra- Suite
Name: L C~~ 1'L Y A ago Phone: ~(a~ 1(S r?L l
Resident/Owner
Address /City /Zip'
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Name: WALL r License ~4~vt'~1 1 w~
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Contractor Address: 3(4Y0 `m G bY. city: B( A W n r
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State: Zip: C ~)1 (1 Phone: 1 5 ~,Q Q (o
Contact- ~11l~1~ ~Y ) 13 Email:
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Type of -Work - New Replacement _ Repair _ Rebuild - Modify Space Work in R.O.W.
Description of work: L 6 W
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation RPZ PVB)
Permit Type Add Plumbing Fixtures Main Lower Level)
Septic System
New Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation (includes $5.00 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)
$105.00 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 aopherstateoriecall.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 pla
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Applicant's Printed Name Applican s Signature
FOR OFFICE USE Reviewed By: Date:
Required inspections: Under Ground Rough-ln -Air Test ,-Gas Test -Final
Oct 07 2014 0824AM HP Fax page 7
Use BLUE or BLACK fnk
� For Office Use r I
C�t O j Permit# I� ��� �
Ly f�a�a� ; � ;
� Perm�t Fee� � ` I
3830 Pllot Knob Road
Ea an MN 55122 �
9 Date Received: �
PhonQ:(651)675-5675 �
Fex:(651) 675-5694 Staff: I
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2014 RESIDENTI14L BUILDING PERMIT APP�ICATION
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Date: �"��� a Site Address; �� ��' i �� f��'l 1,�Yv � � ��� �
— unn ai'
Name: ��.��='��", ��/=. ,�r'�:� �`;, L,, �„-
Phone:
ResidenU
Owner Address I City I Zip:_' �h?yr�v-
Applicant is: Owner �f Contraclor
Type of Wcrk Description of work � ��• ��...- �� � • �' •�"�a.
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Construction Cost: �7 �Z��Y . � Mulii-Family Building: (Yes G°�No�
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Company• ��. . ,.' f =:���✓�+ r ``'�1'� , , Contact: �r'.��`9'`�-,t.''�.-�--�--..
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Contractor Address:���':.� '1.7;��l3��•.=e'; Fr��'" �'����>�:i�' � City: ��''��%��`c.-�.���
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State!°`�`�°�'� Zip: �°`5�`�,� Phone: � ���' '?,��� ���Email.���c,c;',_.��r.��*er'���^'si�C�'.��:��•�.�r•+.
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License fiE: ,a�%~1��'� �'�,.� Lead Certificate#: .��''���"°�w%°"?.�� " �
If the project is exempt from lead certificatlon, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the City of Eegan Issued a permit for a aimila�plan based on a master plan?
_Yes _No If yes: da4e and address of master plan:
Licensed Plumber: Phone:
Meehanlcal Contractor: Phone:
� Sewer&Water Contractor: Phone:
NOTE:Plans and supporting documents that you subm/t a�e considered to be pu6llc Information. Port�ons of
the Informatlon may be c/assffied as non public if you provlde specitic raasar►s that wouid permit fhe Clty to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at 651)454-0002 for protection against underground utility damage. Cali 48 hours
before you intend to dig to receive iocates of underground utilities. www. o herstateonecall or
I hereby acknowledge that this information is complete and accuraie;that the wo�c 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 perrtiit, and woric is not to slart 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.
Exterlor ��hortzed by a bullding permlt issued in accordance wlth ihe Minnesota State Bullding Code must e completed wlihln 180
da pe�m�t+7ssuance. -�•---�:,�,:....: �,
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Appllcant's Printed Neme ApplicanYs Slgneture j
Page t ot 3
Use BLUE or BLACK Ink
r————————————————�
I For Office Use �
' � Permit#: �� j
Clt� 0� ����Il ' ��,'��� '
� Permit Fee: �
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax: (651)675-5694 I Staff: I
� I
2015 RESIDENTIAL BUILDING PERMIT APPLICATI�� ��.�z�
Date: �� ��/�S� Site Address: � "��� �/��� ��G �o� `" )� Unit#:
��, �.� .. ; Name:�.. , C�I�YY�, . ... ����i{.��,,..�j�Gc/�,.�w.w�.r�4_.._. �.�_�.......�.,�.�.m,_Phone:�.�,.��.<.�...�,..�.��,.,.�,e._,...�.,..._._s
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� R�S�tl�r�fi1 ` s
� Q�y�Er � Address/City/Zip: ��"�'' �
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� � Apphcant is. Owner Contractor
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� ����� � Descriptionofwork: ��✓�� �^r�
� Ty�e 0�'lill�ri� �
� � Construction Cos#: Multi-Family Building: (Yes /No_) �
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� ( Company:�tNf�� (�-{?�� ��G��1� �h�, Contact: �f �Ut r�� ,
a � . . j �! l//" N SI.tl7G ��� ���� � �
� � Address: ��� Vl�G���'� �sI City: �
Cot�#ra�t��r � ,, ,y
; State:�Zip: �Sy�� Phone: `7U3-S,S�.Un'�1 Email: ��� � �ov�.19�in.o+-�f�yY�"�vf_ �
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� � License# �G `��� ��� Lead Certificate#
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� If the project is exempt from lead certification, please explain why:
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COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING �
� In the last 12 months, has the CiTy of Eagan issued a permit for a similar plan based on a master plan? �
#
Yes No lf yes,date and address of master plan: �
i �
z Licensed Plumber: Phone: �
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor• Phone. �
IV�JT�':l��a�s.a��tr�vo���g dor�t�€���t�at,�ow s����e co��t`t�l�red to be paa�����'��, I�c��'r�of �
; t��►��orr�a�� r�a��ie Gl�ss��'ed�nQn p�a6��%�yot�pro�e s�er�r�ea��►�s t�at w�t�per��"t��Cf�to �
��.,�. cor��Jude t�ia�t�s are t�a�s�r�. � .��...w;
CALL BEFORE YOU DIG. Cali 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.qopherstateonecall.orq
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 perrnit, and work is not to start without a permit; that the work will be in
accordance with the approved p�an in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota S t Building Code must be completed within 180
days of permit issuance.
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Applicant's Printed Name Appli s Sign ture
Page 1 of 3