unit 105 Use BLUE or BLACK Ink
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1 For Office Use
&&G/City of Eajafl'
I Permit#: i
3830 Pilot Knob Road I Permit Fee: 46C `n j
Eagan MN 55122 MAY 16 2016 1
I
Date Received: I
Phone: (651) 675-5675 I
Fax:(651) 675-5694 I Start: I
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2015 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date:
Site Address: ,
Tenant: W, a4�
{ m, Suite#:
� Reslde`nti nW _; Name: Phone:
Address/City/Zip:
7 Name: M4 ert CO pang Inc dba Culligan Water C641376.
, ¢
License#:
iNx o trctor� w Address: Inver Grove H ts.
City:
� � . Stater Mn Zip 55077 Phone: 651-451-224r
' Contact William R Milbert Email:
—New —Replacement
_Repair _Rebuild —Modify Space Work in R.O.W.
,? Description of work:
F. RESIDENTIAL
T '
Water Heater
Lawn Irri ation X—Water Softener
g (—RPZ/—PVB)
s
k Septic System Add Plumbing Fixtures(_Main/ Lower Level)
t —New Water Tumaround
t .r= _Abandonment
RESIDENTIAL FEES:
$60.00'JVater Heater,Water Softener,or Water Heater and Softener(includes$5.00 State Surcharge)
$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)
$115.00 Septic System New($10.00 per as built)(includes County fee and$5.00 State Surcharge) R O O
TOTAL FEES$ U.
CALL BEFORE YOU DIG. Call Gopher State One Cali 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.000herstateonecall.ora
1 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 1 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 w h the approved Mari in.the case of work hich requires a review and appro of plan
X
Applicant's Printed Name Applicant's Signature
Re uire. .Inspe cons� � . ., r as
Me er,�Relate.d tee" s�t °X
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA136831
Date Issued:06/01/2016
Permit Category:ePermit
Site Address: 3070 Shields Dr 105
Lot:480 Block: 01 Addition: Lemay Lake Hills Townhomes
PID:10-44651-01-480
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 -
Michael B Moen Trust
3070 Shields Dr Unit 105
Eagan MN 55121
(612) 386-5066
Home Depot At Home Services
6224 Lakeland Avenue N, #102
Booklyn Park MN 55428
(763) 542-8826
Applicant/Permitee: Signature Issued By: Signature