3440 Golfview Dr #116 t Use BLUE or BLACK Ink
City of Eaau 0ql 9G11
FEB272017 ,
For Office Use
Perit# (e
Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 Date Received: 07-'-i'/7
Phone: (651)675-5675
Staff:
Fax: (651)675-5694 7 _.
2017 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 2/22/2017site Address: 3440 Golfview Dr# 116
Tenant:_ Suite#:
MAIMEMPIEPIMMIVI
:_ `O° w 3 Name. Washkowiak Phone: 972-259-7797
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_`£ _R ,t t.EE, ,_i _ Address/City/Zip:
3440 Golfview Drive # 116
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I Window Concepts of Minnesota PC644711
7121101116i121,01„� } "� Name: License#:
' t}onti Address: 291 Eva Street City: Saint Paul
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Contact:ormittaisamtwommili
Tim Andrew Email: tim.andrew@windowconceptsmn.com
T � �w _New Replacement _Repair _Rebuild _Modify Space _Work in R.O.W.
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k Description of work: Replacing existing shower pan and shower fixtures.
t ,ielitil#1 RESIDENTIAL
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Niliggiggiallentrativi.,:ameWater Heater
Water Softener
AAMutMonVJgmt.W„lmift Lawn Irrigation(_RPZ/_PVB)
Septic System ✓ Add Plumbing Fixtures ( Main/_Lower Level)
111111,11110-SEM Water Turnaround
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Miliathilititatignat _Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation (includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround*(includes State Surcharge)
*Water Turnaround (add $280.00 if a 3/4"meter is required)
$115.00 Septic System New(includes County fee and State Surcharge)
TOTAL FEES $60.00
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.gopherstateonecall.orq
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 approval of plans.
x Tim Andrew z .-_ _ei/
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Applicant's Printed Name Applicant's Signature
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA143928
Date Issued:07/05/2017
Permit Category:ePermit
Site Address: 3440 Golfview Dr 116
Lot:325 Block: 03 Addition: Tomark
PID:10-76900-03-325
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
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: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Toni L Washkowiak
3440 Golfview Dr 116
Eagan MN 55123
(972) 259-7797
J Carver Construction Inc
1345 Schletti St
St. Paul MN 55117
(651) 645-5488
Applicant/Permitee: Signature Issued By: Signature