EA189467 - Plumbing - Fixtures - Issued Date 03/01/2024 PERMIT
City of Eagan ® , Permit Type: Plumbing
3830 Pilot Knob Rd -+ %;,p®, Permit Number: EA189467
Eagan, MN 55122 -- EAGAN
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(651)675-5675 �e
www.cityofeagan.com * E R 1 8 9 4 6 7
Date Issued: 3/1/2024
Site Address: 647 Atlantic Hill Dr
Lot: 4 Block: 1 Addition: Lakeside Estates
PID:10-44300-01-040 Sm M1
Use: * 10 - 44300 - 0 1 - 040
Description:
Sub Type: Fixtures
Work Type: Replace
Description: Bathroom Remodel
Meter Size Meter Type 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:
Tony's Plumbing Stuart B&Kathleen Samsky
4572 LaSalle Avenue NE 647 Atlantic Hill Dr
St.Michael MN 55376 Saint Paul MN 55123--200
(612)578-2839
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
--------
f I For Office Use 1+/�
�0 1 Permit#: "
EAGAN
IPermit Fee: I
I I
I Date Received: I
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 I I
(651)675-5675 1 FAX: (651)675-5694 Staff: J
build inginspectionsCcDcityofeagan.com —————————————
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RESIDENTIAL'' PLUMBING PERMIT APPLICATION b'f
Date: �— �7 Site Address: 7 de(7�/A✓l7L'I C 61% Unit#:
Applicant is: ❑ Owner ;5 Contractor
Name:
Homeowner
Address: � � City: �',4P�9✓1
State: / ' 'v111!ip: Phone: Email:
Type of Work —New _Replacement _Repair X Rebuild —Modify Space —Work in R.O.W.
Description of work:
Tankless Water Heater
Standard Water Heater Lawn Irrigation(—RPZ/—PVB)
Description Water Softener Add Plumbing Fixtures(—Main/—rL,owe Leel)
/
Septic System Description:A SfAiV, /Q/ SNO
Connection to City Water from Well eL✓-710 I� �e
—New —Abandonment
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Company: vin � Contact: i �--
Plumbing Address: 5 A / e �f/2 /�• City. 51c �z
Contractor
State:An Zip: 3 Phone4ia 57 '.? J ILmai1:
License#: K Expiration Date: �� J
RESIDENTIAL FEES
$150.00 New Residential or Connection to City Water(includes State Surcharge)
$65.00 Water Heater,Water Softener, or Water Heater and Softener(includes State Surcharge)
$65.00 Lawn Irrigation(includes State Surcharge)
$65.00 New fixtures, adding, altering, or removing piping (includes State Surcharge)
$65.00 Septic System Abandonment(includes State Surcharge)
TOTAL FEES$
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.
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 approv Tans.
115-7- 191
Appli 'cant's P ted Name Applican s Ygtture
FOR OFFICE USE
Reviewed By: Date:
Meter Size(if applicable):
Required Inspections: Under Ground Rough-In Air Test Gas Test Manometer Final