3545 Blue Jay Way - Unit 107 l
For Office Use�
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Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD:(651)454-8535 I FAX: (651)675-5694 APR 0 9 2018 Staff:
L. ai J
2018 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 41114 h t Site Address: 3545 Blue Jay Way, #107
Tenant: Suite#:
ResitlentiOwner
.� Name: Jane McSherry Phone: 651-235-8301
Address/city/Zip: 3545 Blue Jay Way, #107, Eagan, MN 55123
Name: Tim's Quality Plumbing License#: PC 643755
ontractalr
Address 225 County Road 81 City: Osseo
state: MN Zip: 55369 Phone: 651-454-1010
Contact Tim Lindholm Email: speedyplumbing@comcast.net
Work —New ✓ Replacement _Repair _Rebuild _Modify Space _Work in R.O.W.
Description of work: replace gas water heater
RESIDENTIAL
X Water Heater
Water Softener
Lawn Irrigation( RPZ/_PVB)
Per,711t,Type Add Plumbing Fixtures( Main/_Lower Level)
Septic System
New Water Turnaround
_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) 60.00
$115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES$
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.
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
website at,
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 Mary Belobaba xakii c_6se/34 _
Applicant's Printed Name Applicant's Sign ture
P �PFICE US Reviewed Date
Require Inspections Und rowRetfgh-tn Airiest Ge Tem Finai
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