3629 St. Francis Way A Use BLUE or BLACK ink
� For Office Use j
2 � I
Clt of Ea a� � Permit#:��,�,�_,�_ �
Y � � � �
� Permit Fee:�,Q('� , �
3830 Pilot Knob Road
Eagan MN 55122 RECEIVED � Date Received: � `� � �
Phone: (651)675-5675 _`—
Fax: (651)675-5694 � Staf�J �
OCT 0 9 2015 -------------�
2013 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: I��' � ! �� Site Address: ���"'�� -5 l - %��r�lz.��jS� (,�/�� � �
Tenant: � ���. � �' ����it� � Suite#: �
' Resident%Owner' Name: -� � Phone: �'�����1�lCv��
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Address/City/Zip:_ (r.a��4`�; /y](v� �S ,�l o��j
Name: LCG 3't'26°"I�fi5 �(`f,G Gc.��Ti���'- CU � ����``GA,_.��
License#:
Address: `%�.�L' rt� ���� ' ' �
Contractor �5�� (`�: ��� City: ��G�"l��
State: � � Zip: r`� 5�`� `� / Phone: ��u -� _��-�,7 T°1
Contact: ���� �-l°'�" � Email:
� T � �e�Of�WOf �New _Replacement _Repair _Rebuild Modi S ace
yp k .. — — fY p _Work m R.O.W.
' �! Description of work: � e� /I��,c,r,,,� �,���, �,
RESIDENTIAL
Water Heater
Lawn Irri ation �Water Softener
Permit T e g �RPZ I_PVB)
yp Add Plumbin Fixtures
Septic System 8 (___Main/_Lower Level)
New Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes$5.0o State Surcharge) �v �..
$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)
$105.00 Septic System New($10.00 per as built)(includes County fee and$5.00 State Surcharge)
TOTAL FEES$ G����-�C�
CALL BEFORE YOU DIG. Call Gopher State One Call at(651j 454-0002 for protection against underground utPlity damage. � /
Call 48 hours before you intend to dig to receive locates of underground utilities. www.aooherstateonecall orp
� 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 fhe case of work which requires a review and approval of plans.
x_ ,�,l�G� �-��T� �' ._ -� .
X 0 � ' � �'� �/'
ApplicanYs Printed Name Appli�ant s S�gnature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: _Under Ground Rough-In Air Test Gas Test Final
Use BLUE or BLACK Ink
---------,
� For Office Use �
Cl6 Ol �4 u11 RECEIVED i Permit#: /��7 7� �
� � � Permit Fee: (�c�',�`'' �
3830 Pilot Knob Road OCT � 5 20�5 i i
Eagan MN 55122 I Date Received: �
Phone: (651)675-5675 � �
� Staff: �
Fax: (651) 675-5694 � I
. ��.���������.����.��J
2013 RESIDENTIAL PLUMBING PERMIT APPLICATION
�� aate:"��� �e� " ° � �� s�te aadress:_ ��� � �S'i �=.������;fs crd��
Tenant: ��1��:- �,�� Suite#: �
ResidentiOwner, ` Name:_ rCJ�i-iJ C y tfd� F� Pnone:_ ���- 1`l'f' ���
Address/City/Zip: �����
� � � � Name:__ C�'��V�'!k`�;�' %l'� � C,�.��'�-�� LG License#: � �����C1,d L
Address: l�-5� C c,� �s�" ����C=� C_ ��
Contracfor � - �°`� ��"��� ��ty� t3 �j �
' State: ��i AJ Zip: .�� �Y 9 Phone: ��u.� ��--� �-'��°l
'� Contact: �--5� �(i�l� EmaiL•
T e Of Wo1'k:. �New _Replacement _Repair _Rebuild _Modify Space Work in R.O.W.
Yp —
1
Description of work: �� � �e�.,
�RES ENTIAL
ater Heater
Water Softener
Lawn Irrigation�RPZ/ PVB)
Permit Type Add Plumbin Fixtures Main/ Lower Level
: Septic System 9 �-- — )
_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 Irrlgation (includes$5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Turnaround*(includes$5.0o 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.qopherstafeonecall.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 approva!of plans.
x �l.S��" 1--��-� X _ �
ApplicanYs Printed Name A li nt's Signat re ,
�
FOR OFFICE USE Reviewed By: Date: .���
4 �
�rt
Required Inspections: _Under Ground Rough-In _Air Test Gas Test Final
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA132994
Date Issued:09/15/2015
Permit Category:ePermit
Site Address: 3629 St Francis Way A
Lot:007 Block: 04 Addition: St Francis Wood 4th
PID:10-65903-04-007
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
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 -
Nancy L Hagen
3629 St Francis Way A
Eagan MN 55123
(612) 991-1626
Blue Ox Heating & Air Llc
5720 International Pkwy
New Hope MN 55428
(612) 238-9709
Applicant/Permitee: Signature Issued By: Signature