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1903 Silver Bell Rd Unit 209
- - - - - - - - - - - - - - - - - f I For Office Use _ (1 City of Ea~.,~ Permit 2S / r -2' J I Permit Fee: ~ 7 I 3830 Pilot Knob Road I ` Eagan MN 55122 Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 Staff: C _ Z"4 L----------------I 2009 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: © ( Site Address: Tenant: o (K v y ?2 > Suite O7O RESIDENT / OWNER Name: k1{I/N Phone: 9 3 P q.3 Address/ City /Zip:/~'O3 5tli ev b,(>'~ C~4 CONTRACTOR Name: C rU/ 1©i 7 L C License ' /C) 0 ^7 Address: t ul(lk,a,le- / yy~~ Uy City: /54 p/2/( (,)a State: Zip: -f V Phone: Contact Person: to k i y y ~c TYPE OF WORK New _i/Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Heater Water Softener Lawn Irrigation V "Add Plumbing Fixtures RPZ / - PVB) Main - Lower Level) Septic System Water Turnaround New Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation (includes $.50 State Surcharge) $50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) *Water Turnaround (add $165.00 if a 5/8" meter is required) $100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge) $90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES $ 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 20 _714 ~ vct y ~ x y,4 Applicant's Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground -Rough-In Air Test Gas Test Final