unit D ------------------
For Office Use
f
00 � I Permit#:EAGAN
• •��� j Permit Fee: 0
" I Date Received: I
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 I I
(651)675-5675 1 FAX: (651)675-5694 I Staff:
buildinginspectionsecityofeagan.com I ------J
2021 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 1'6 1,3 b a� l Site Address:
Tenant: Suite M
` _.` p
ResideResident/Owner Name: Phone:�
Address/City/Zip:
Name: License#:
Contractor Address: City:
State: Zip: Phone:
Contact: Email:
Type of Work —New replacement _Repair —Rebuild _Modify Space _Work in R.O.W.
Description of work:
Tankless Water Heater
Lawn Irrigation(—RPZ/_PVB)
Standard Water Heater
Description Add Plumbing Fixtures�Main/_Lower Level)
p Water Softener
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*+ $300 for Meter and $205 for Radio Read = $565
*Sewer&Water Permit also required for connection charges
TOTAL FEES $
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.citvofeagan.com/subscribe.
CALL BEFORE YOU DIG. Contact Gopher State One Call at(651)454-0002 or www.gopherstateonecall.orq for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
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 ( (I2_-f -�n U r -�e�rt— x
Applicant's l5rinted Name Applicant's Signature