EA186741 - Plumbing - Fixtures - Issued Date 09/14/2023 PERMIT
City of Eagan , , , Permit Type: Plumbing
3830 Pilot Knob Rd •-.�- Permit Number: EA186741
Eagan,MN 55122 •-•- •--• EAUAN
(651)675-5675 111111111111 IN 1111111111111111111111111
www.cityofeagan.com * E R 1 8 6 7 4 1
Date Issued: 9/14/2023
Site Address: 1591 Blackhawk Lake Dr
Lot: 10 Block: 2 Addition: Blackhawk Glen 3rd
PID:10-14352-02-100
Use: * 10 14352 - 02 - 10 d *
Description:
Sub Type: Fixtures
Work Type: Replace
Description: shower and sinks
Meter Size Meter Tyne Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: PL-Plumbing Permit Fee $64.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
Total: $65.00
Contractor: - Applicant - Owner:
Minnesota Rusco Michael D&Lisa M Sackmaster
5010 Hwy 169 N 1591 Blackhawk Lake Dr
Brooklyn Park MN 55428 Eagan MN 55122--124
(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