1665 Hickory Lane For Office Use
* ' € : ° EAGAN� Permit#:
....0 .,..,...... E AG A N Permit Fee: f
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff:
buildinginspections(c�cityofeagan.com L
2018 RESIDENTIAL BUILDING PERMIT APPLICATION #n(c,���y
Date: Site Address:/7.Z /Z� -'
/-7/-6Me, ��7 Unit#: ff/ l ;/ *-
...�M.� � � too s s� �'Phone: 6 S!- � .�
,/ ,(� 5�- 7 coq
iName: ° e �1QOG�'t�l�r5 / I Phone: ( [
Resident/ 16 GS 14.-`, ckur7 t _1\`
Owner Address/City I Zip:
Applicant is: Owner Contractor
Type of Work Description of work:
kse- Ro(��f
4
Construction Cost: TaO Multi-Family Building: (Yes /No )
Company: 60 C lMa tt VI Al rd.St"n11 atL' 9ontact: 4-5./�1/* r or t't( n17
q
Address: / 75!3 Fb X 6Cr0 C7L City: / rr i.`ti 9 X, __ /a�
!, Contractor �J `V9
�� 5.50c ' 75-01-87f-e5�16
State: Zip: Phone: Email:
6 G C loo 6 {
_'License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
No 11-€0. 4 8 : l f— ,`r� 80_siCOMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes, date and address of master plan:
,
Licensed Plumber: Phone:
Mechanical Contractor: Phone: I
E
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
r NOTE:Plans and supporting documents that you submit are considered to be public information. Portions of the information may be
classified as nonpublic if yodprovide,specific reasons that would permit the Cit to conclude that the are trade secrets.
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 www.citvofeaoan.com/subscribe.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
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.qopherstateonecall.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 if.i-.as.
x 51--t v-e Pt ianinct,tt A x orJO
veitiL'� ,i Vii/
Applicant's Printed Name Applicant's -ter
f For Office Use
Permit#: '1.600
E AGA N
Permit Fee:
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff:
buildinginspections@citvofeagan.com
2019 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date:
!/13 /1 9 Site Address: 1kL(
Tenant: Suite#:
Resident/Owner Name: 41A/`j b'I / Phone: `�/- �9-�:d 3`3
Address/City/Zip: /6 ,G/[c Lexis'-7, 4,10 /�ll�.�� o-:
Name: Ar.11 A- 12-6 g ' -A)5t 95 ) z L- License#: }'c--(- `f 4-1,x-1
Contractor Address. ��5 f d' —�✓ '� City: z— P.4-cu a-
State: 4/1/19 Zip: crcB `t Phone: 6 6 -/ '9 -- 394 9
Contact:j7411-1.) 7£)
Type of Work —New 2-Replacement _Repair _Rebuild —Modify Space —Work in R.O.W.
D ription of work: ? ��G GLprY�-
Water Heater
Lawn Irrigation ( RPZ/—PVB)
Water Softener
Description Add Plumbing Fixtures ( Main/ Lower Level)
Septic System
Description:
New
Abandonment Connection to City Water from Well
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 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
*Sewer&Water Permit also required for connection charges
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. www.00pherstateonecall.orq
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 www.cityofeagan.com/subscribe.
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
accordanceb,4.-pi
with the approved plan in the case of work which requires a review and approval of plans. ,� o
x % /04..7.19 'keiAr x
Applicant's Printed Name Applicant's Signature
Page 1 of 2
FOR OFFICE USE
Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
Meter Related Items: Meter Size Radio Read - Manometer Staff:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 TDD: (651)454-8535 FAX: (651)675-5694 buildinginspections@citvofeagan.com
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