Unit A Use BLUE or BLACK Ink
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I For Office Use
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' EC Permit l go? e 7 I
Fbi~ yof EapC E IVE I Permit Fee: vV
3830 Pilot Knob Road
Eagan MN 55122 JUN 0 2 2014 i Date Received: -o?r
Phone: (651) 675-5675
Fax: (651) 675-5694 BYM/--A -12-0? 9 L--Staff:
2014 RESIDENTIAL-PLUMBING PERMIT APPLICATION
Date: Site Address: I G C`lf 1 1 r~,on Dr
Tenant: Suite
Name: Phone:
Resident/Owner
Address /City/ Zip: K bo~ A 0 (rm'<
Name: ~rvtk ~ ~ t_ice se
Address: CA OCity:
Contractor
State: _ Zip: ~`1 l Phone: G I -9j9-0q
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C~, k
Contact:, )1~ '.X%h®6-( Email: 01X i
Type of Work -New X Replacement _Repair -Rebuild - Modify Space - Work in R.O.W.
Description of work:
RESIDENTIAL
r
Water Heater
Water Softener
Lawn irrigation RPZ PVB)
Permit Type { Add Plumbing Fixtures Main J - Lower Level)
Septic System
New Water Turnaround
Abandonment Y
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) r
$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) y
*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)
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TOTAL FEES $ L/
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.ciopherstateonecall.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 pro of plans.
X )I M sc-'~ (3 6(f,( Applicant's Printed Name Applic 's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
Me**t R laced lull s: Mdt~r ~ i. Radio Read ta€f:.;
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA139520
Date Issued:10/26/2016
Permit Category:ePermit
Site Address: 1600 Clemson Dr A
Lot:57 Block: 01 Addition: Thomas Lake Heights 2nd
PID:10-75951-01-570
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Molly J Clark
1600 Clemson Dr
Eagan MN 55122
(612) 812-5031
Window Concepts Mn
291 Eva St
St Paul MN 55107
(651) 905-0105
Applicant/Permitee: Signature Issued By: Signature