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3551 Blue Jay Way #200 Jan 28 2817 89,37:48 Via Fax —> 6516755694 City of Eagan Page 882 Of 882 Uee.13LUE or BLACK tnk . . 1 CL...- •:,_' For Office . •. ; .. Permit I4o -7-7V tmiCIal . �-.D .f _, " . ....__" . _.. 3830'Pitot Knob'Road 1 ;Eagan MN 55122 1 bate Received:.,.,",w,rv,..____, I. Phane:'(65I)675.5'675 I staff Fax:(651)675.5694 • _ 2017 RESIDENTIAL PLUMBING PERMIT APPLICATION j .,rf:::',i � 1 .11 � !ii 41 t 1 \ I%'t• ' ":1 ( . ' ate: : Site Adcraas: + . ; ,;• ,�,. • Iw, w r .. •,,. " i. .w_., w x wx ,. • `.en nt.: Suite 4: " . 5555.+.•�... 555 .: I J l o• 14.0titto wn: Mime 1 i' le 1. '✓L/ �'`" Phone: w . ,w", w a :? •1'"'. ,{ ,, /t f 1 >/ a 1 ,I' Ji. I 11 f7 I` t/ Address S 6� 3 d ..sw /CIE /Li v � ; �;; ;; ^:: -• wrrw.w,�w,.,,,xry ..�.,.,w._ ' �;z k ki f3 \. �A es' xr !!rr " irvrrvivnurwwxw rviwwr wxvrvm,wwrrrwwmwr u,wrnrvxuuxuxuuwnrx�nrnww�rnuu, .uvxrvxuu,�urixuunuuuu�nw.�un....wi� -,:,....,:4:-;.......::„...':::....;;:;.1.4e.....- , "".n.._................._xa.. 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Water Heater :,i:}:::•::::::::..::>.•::S:.:.:2•i:5:�.:.;:;.:,:•�:•:;:;'......:+:'5555:,5555,, .......... Water Softener ..::; ..:,•.�::, . 6:„;:ii,.a`',••;f ^b:';:,!,5• ,_.._...._iaw�Irrigation( �PZ/ 555avf • , 5 : ';r.,., 0 i Add Plumbing Fixtures .,,Main/ Lower Level): aeitbSystem Now Water Turnaround .w� Q Abandonment ------,.,._...W._.._.. . .. .__.www ..— :RESID , TIAL FEES: ' $60.00 Water Heater,Water Softener,or Water Heater And Softener(includes State Surcharge) $60:00 Lawn Irrigation(in•ciudes State Surcharge) $60,00 Add Plumbing Fixtures,Sgta x y19,r0„,A,gagsar r1t,Water''Turnaround°(includes State Surcharge) • "Water Turnaround.(add$280,00 if a 5/4''meter is required) $115.00 Si ptic:Syetern Nevi!(includes County fee.and State Surcharge) TOTAL FEES S 5555 ' .CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. ' '' Cfall 48 hours before you intend to'dig to receive locales Of underground utilities. yAvw;C„I,ophealet's:,c)z't0_w,»,E11t.urc, 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, bin only an application for a permit, and work is not to start without a permit; that the work will be in "'t3rrccrdence with the approved plan in the case of work which requires a review and approval of plans. r, ,1 ti/ ray j l i )P:„ .. 1 .a If .w+ww.L. r.`_ x .x "'' ..,r ' : ,Appitcant:'s!'Printed Name Applicant's'S`9natur ”" e,r c"1 Vs';Y'ai:+�s��w•gw•�,�,,tc ,'��+ifi y.� ,..,..,.. ,........ .+,,.+ 1;9��.•'e.•::t:`: ...:..r,......, `:t'. It%iA'17.•i.:'i t;. "+�i"ia�rVim'�^�,,, ,.. .. .. W t :....,... 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