1000 Blue Gentian Cir07/15/2t A 15:01 FA%
City of Eaian
3630 Piiot Knab Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Q002
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I For dtf?ce:'?'s.? ?
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? PermR #: v? 1 ? ?
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1 Permit Fee: I
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? Date Received: (
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i staff: _ i
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2008 RESIDENTIAL PLUMBiNG PERIIAtT APPLICATl4N
Date' '7- / 7J 02 Site Address• ?A-?i "?'il <'i
Tenant:
Suite #:
RE8(DENT ! OWNER Name: 44 14 K u G? Phone:
Address ! Ciry / Zip:
CONTRACTOR Name: License #:
Rddress? ff ?
City: I ! r?t QState: 0? 14 Z[p: S'ro 8?
Phona: 5-(-2 Contact Person: &01 !4'z/1_ e?--
TYPE oF woRK ..? New _, Replacement _ Repair - RebuiVd _ ModNy Space _ Wot1c in R.O.W.
Descrl tlon of work:
PERMIT TYPE RESIDENTIAL
Water Heater Water Softener
l.awn Irrigation Add f'lumbing Fixtures
? RPZ /_ PVB) ? Main _ Lower Level)
v Septic Syslem Water 7umaround
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Abandonment
RES/DENTIAI. FEES:
$60.50 Minium Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (inciudes $.50 State Surcharge)
$50.50 Add Piumbing Fixtures, Septic System Abandanmenx, Water Turnaround` (inciudes $40 State Surcharge)
"Water Turnaround (add $136.00 if a 5l8" meter is requlred)
$100.60 SeptlC SyStem New ($10.00 per as built) (inciudes Caunty fee and $.50 State Surcharge)
$50.50 Fit'e Repair (replace bumed out apptiances, ductwork, etc.) (fncludes $:50 State Surcharge) ? o
TOTAL FEES S
I hereby acknowledpe that this Information is complete and accurate; that the work will 4e 1n oonrortnance wan me oremances ana cvaes or inr %,Pry vi
Eagfln; that I understand this 16 not a permit, but only en appliCStlon tor a permit, and worlc 19 not to start without e lk thai the work will be in
accordsncs wiM the approved•plan in the caae of work whleh requlres a review and appropl of plans.
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Applicant' PHnEed Na e .
FOR OFFICE U3E
Appltcant's
Reviewed By:
Date:
Requlred Inspectians: ._Under Ground __Raugh-In ,_Air Test _,Gas Test _Final
City of Eap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
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? ?o:r?raffiee l1's'? I
?
j Permit #:
i Permit Fee: 4?0.
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? Date Received: ?
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I Staff: ?
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2008 2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Daie: C-) Site Address: /d oo 6CK TiGCt1 ? ?.{ Q!1
Tenant: ?aGa viSuite #: ?
RESIDENT / OWNER Name: ov?4121k'irirc.°s Phone:
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Address / City / Zip; o? ? 3 1; r L?? ? 1`!J ? S?•r?'? t?-? ?
Applicant is: ?-6avrrer ? Contractor
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TYPE OF WOR Description of work:
Construction Cost: Multi-Family Building: (Yes No X-)
CONTRACTOR i-/
Name: ?r? Tq ?/?eean- r' License #:
Address:
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)i?4604St
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City:
Phone: 057 73 5 a- Contact Person: WaF' /? G'
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Cate ory 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet :• New Energy Code Worksheet
C8tBg01'y Submitted Submitted
(q submission type) • Energy Envelope Calculations Submitted
?
In the last 12 monihs, has the City ot Eagan issued a permit for a similar plan based on a master plan?
,Yes -No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
` NOTE. P, lans and supp,orting, tlacuments ihat you subr"iai[ are constdered to be publi.c informat?on:.° Portions af ;:;':
'`the Informatfon may 6e classif?ed a? non publrc If you provide;`speciftc reasons that would permit the City,to
?onclude"that the a're tra'de secrets,.'; :' .. ,
I hereby acknowledge that this intormation is complete and accurate; that the work wili be in conformance with the ordinances and codes oT the City of
Eagan; that i understand this is not a permit, but only an application tor a permit, and work is not to start without a permit; that ihe work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
X X
Applicant's Printed Name Applicant's Signatur
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