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945 Wescott Tr - Unit 314EAGAN 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 I TDD: (651) 454-8535 I FAX: (651) 675-5694 buildinainspectionsacityofeagan.com Date. Tenant: Permit #: For Office Use /(o 7ffj Permit Fee: - Od Date Received: Staff: ;02/1 RESIDENTIAL / PLUMBING PERMIT /APPLICATION (% 1 Site Address: ��� SC o j--r( ) / Y1 3/7 J Resldent[Owrler. Name. g- f b — Phone: Address / City / Zip: ontract Name: /T%/ a% ,.• " 00 14/2 L/ . S License #: pc(7 -G-3 C > C / r Address: / ?S b UPI, 4_9 �p LLA./ City: ,�' v(' t°)orr c/ fib) / State:? Zip: �S tr/ Phone: -C/c '- 3cb - > , b Contact: rj 2, j,,,/ Email: Type of ;work ' — New AReplacement Repair Rebuild Modify Space Work in R.O.W. — — — — Description of work: Dicri iron es P Tankless Water Heater Lawn Irrigation ( RPZ / PVB) — Standard Water Heater Add Plumbing Fixtures ( Main / Lower Level) — Water Softener Description: Septic System Connection to City Water from Well New Abandonment RESIDENTIAL FEES $60.00 Water Heater, $60.00 Lawn Irrigation $60.00 New fixtures, $60.00 Septic System $100.00 New Residential $115.00 New Septic $60.00 Connecting *Sewer & Water Water Softener, or Water Heater and Softener (includes State Surcharge) (includes State Surcharge) adding or removing piping (includes State Surcharge) Abandonment (fee collected with Building Permit) System (includes County fee and State Surcharge) to City Water from Well* + $300 for Meter and $205 for Radio Read = $565 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.qopherstateonecall.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.citvofeastan.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 accordance with the approved plan in the case of work which requires a review and approval of plans. Applicant's Printed Name x <_i Applicant's Signatu �i