4255 Pilot Knob Rd - Tie In Card
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Date Received:
3830 PILOT KNOB ROAD' EAGAN, MN 55122-1810
(651)675-56751 TDD: (651)454-85351 FAX: (651)675-5694 Staff:+ .
buildinginspections aAcityofeagan.com
2019 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: aeila Address: I 3 55/a
Tenant: ' , .
.._.-_-- ..- •n--r;riz*s=..,*J.._. .._..___ _ _ .._ - Suite #:
+ ,f'.- Name: A.L. b. L:44 4
f'a`y'st Address/City/Zip: J • - J '%
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Name: MILBERT COMPANY dba CULLIGAN WATER License it: WC641376
C'Gt1t'f aGa 0'P: Address: 1801 50TH STREET EAST City: INVER GROVE HEIGHTS
State: MN Zip:, 55077 Phone: 651-451-2241
Contact: BILL MILBERT Email: gloria.abas@culligan4water.com
Typ:e`01::.Work. -- New --_Replacement Repair Rebuild _ Modify Space _Work in R.O.W.
Description of work:
Water Heater ...
Lawn Irrigation•( RPZ/ PVB): • .
•
y ,Water Softener
Desert tl'a.n Add PlumbingFixtures -
p ( Main/;Lower Level}
��Septic System
Description:
New
__Abandonment Connection to City Water from Well
RESIDENTIALFEES ....__.�...._.,...._...____..._ ._._...__........__Y.. _.....__..__.�w........_._.__. ..._-._.._._..__._._...._._..__.,_.__........_...
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$60.00 Water Heater,Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation (includes State Surcharge)
$60.00 New fixtures, adding or removing piping (includes State Surcharge)
$60.00 Septic System Abandonment
$100.00 New Residential (fee collected with Building Permit)
$115.00 New Septic System (includes County fee and State Surcharge)
+$60.00 Connecting to City Water from Well* + $290 for Meter and $190 for Radio Read = $540
R *Sewer&Water Permit also required for connection charges
I...... . w ,.. TOTAL FEES $ GO.00
CALL-.3EFOR YOU-DIG, Call GophSt
er- ate Ono Call al tG51)454-0002 for proleclio.n against underground utility damage. Call 4t3 hours before you
intend to dig to receive locates of underground utilities. www.gopherstateonecall.ory
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
wobslto at www.cityofoagan.comisubscribo.
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
ac ordance 'Ih the approved plan I he case o work which requires a review and approval f plans.
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Applicant's Printed Name Applicant's Signature
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