EA186117 - Plumbing - Fixtures - Issued Date 08/16/2023 PERMIT
City of EaganPermit Type: Plumbing
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Permit Number: EA186117
3830 Pilot Knob Rd
Eagan,MN 55122 °'m' """°
EAGAN
(651)675-5675 * E A 1 8 6 1 1 7 K
www.cityofeagan.com Date Issued: 8/16/2023
Site Address: 3716 Greensboro Dr
Lot: 5 Block: 4 Addition: Greensboro 2nd
PID:10-30901-04-050
Use: * 1 � - 3 (d9
Description:
Sub Type: Fixtures
Work Type: New
Description:
Meter Size Meter Type Manufacturer Serial Number Remote Number
Line Size
Comments:
PL-Plumbing Permit Fee $64.00 0801.4087
Fee Summary: Surcharge-Fixed $1.00 9001.2195
Total: $65.00
Contractor: - Applicant - Owner:
Minnesota Rusco Alfred C&Karen L Baker
5010 Hwy 169 N 3716 Greensboro Dr
Brooklyn Park MN 55428 Saint Paul MN 55123-224
(952)935-9669
This permit shall be null and void if work does not start within 180 days of issuance,or if work is suspended for 180 days or more after
started.
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.
Applicant/Permitee: Signature
Issued By: Signature
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For Office Use
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a � a 90 a I Permit#: I
EAGANPermit Fee:
I Date Received: I
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3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 Staff:
(651)675-5675 1 FAX: (651)675-5694 —————
buildinainspectionsacitvofeaaan.com
RESIDENTIAL PLUMBING PERMIT APPLICATION
Date:
8/16/23 site Address: 3716 Greensboro Dr Eagan, MN 55123 unit#:
Applicant is: ❑ Owner 14 Contractor
Name: Chip Baker
HomeownerAddress: 3716 Greensboro Dr City: Eagan
State: MN Zi : 55123 phone: 651-592-404 Email:
New Replacement _Repair _Rebuild Modify Space _ Work in R.O.W.
Type of Work
Description of work:
Tankless Water Heater Lawn Irrigation (_RPZ/_PVB)
Standard Water Heater V Add Plumbing Fixtures(-V—( Main/_Lower Level)
Description Water Softener Description:
Septic System Connection to City Water from Well
_New _Abandonment
Company:
MN Rusco Contact: Kelli Gugisberg
5010 Hwy 169 N City:
Plumbing Address: New Hope
Contractor MN 55428 952-935-966, Email: kelli@minnesotarusco.com
State: Zip. Phone:
PC80561212/31/23
License#: Expiration Date:
F
SIDENTIAL FEES
0.00 New Residential or Connection to City Water(includes State Surcharge)
.00 Water Heater,Water Softener, or Water Heater and Softener(includes State Surcharge)
.00 Lawn Irrigation(includes State Surcharge)
$65.00 New fixtures, adding, altering, or removing piping(includes State Surcharge)
$65.00 Septic System Abandonment(includes State Surcharge) 7
TOTAL FEES $
CALL BEFORE YOU DIG. Contact Gopher State One Call at(651)454-0002 or www.gopherstateonecall.org for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
work will be in
ormance
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Eaganythat I unldestandtthissis nootnatpermit, but onlyaan applicatonhfortaepermit, and work isfnot to start tw without ordinances h
infraion is completend accurate;tate City of
ape permit; that the work will be n
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accordance with the approved plan in the case of work which requires a review and approval of plans.
X Kelli Gugisberg X
Applicant's Printed Name
Applicant's ig ture
LUSE Reviewed By: Date:
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