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2910 Burnside AveCity of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 2910 Burnside Ave Lot: 1 Block: 3 Addition: Country Home Heights PID:10- 18300 - 010 -03 Use: Description: Sub Type: e- Windows/Doors Work Type: Windows/Doors - New/Replacement Description: House Census Code: 434 - Zoning: Square Feet: 0 Comments: Fee Summary: Valuation: 3,000.00 Contractor: Flannery Construction 1375 St. Anthony Avenue St. Paul MN 55104 (651) 225-1105 PERMIT City of Eaan BL - Base Fee $3K Surcharge - Based on Valuation $3K Applicant/Permitee: Signature - Applicant - Construction Type: Occupancy: Carbon monoxide detectors are required by law in ALL single family homes. Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing inspection. Call for final inspection after installation. $88.50 $1.50 Total: $90.00 Owner: Jerome Johnson 2910 Burnside Ave St Paul MN 55121 Permit Type: Permit Number: Date Issued: Permit Category: 0801 9001 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply of Minnesota Statutes and City of Eagan Ordinances. h all applicable State Issued By: Signature Building EA088799 04/21/2009 ePermit CITY OF EAGAN 3795 PilW Ksob Rood Eeyan, AAN s5122 PHONE: 454-8100 BUILDING PERMIT Receipt # Te be awd fee Est. Vclue . Dote , 19 Site /lddrcss E?ect ? Occuponcy Lot Block Sec/Sub. - y. ,- 'AIter p Zoning Parcel # , Repoir '? Enlarge ? W Name Move 0 ; Address , Demolisfi ? b Ci phoM •- Grode ? oe Name Approrols ? pu Address .. .- ', ' Assessment _ o6,...._ Woter a Sew. Name _ Address Pol ice Firo Enp. Plartner Council 1 hereby acknowledge thot I have reod this opplicotion and stote thot Bldp. Off. the inlormotion is torrect ond ogree to comply with oll opplicOble ?PC - Sfate of Minnesota Statutes ond Gty of Eoqan Ordirances. Sipnoture of Permittee Fire Zone Type of Const. # Stories _ Length Ft. Permit Surctwr9e Plan check SAC Woter Conn. Woter Meter Rood Unit Totol A Building Pertnit Is issued to: on the express condition that all woric sFwll be done in xcordonce with all opplioabk Stafe of Minnesoto Statutes ond City of Eeqen Ordinances. Bufld{np Offlciol Permit No. Permit Holder Misc. Permit No. Holder Plumbiny H.V.A.C. Qt..c? V1 ? C? J-ZS- Wall Water Disp. Sawer Eketric p C.i, 12? r -ZS 4Z fr Inspection Date Insp. Other Footinqs Foundatlon Freminq Rouph PI6y, Rouph HVA Inwlation Firul Plbg Final HVAC Final yyater DescriM Location: YWII Sewer Pr. Disp. Reoeipt --? PLUMBING PERMIT Permit No. CITY OF EAGAN Fee fi!l in numbered spaces S/C Type or Print /egib/y Tot. ? 1. Date 2. Installation Cost 3 ? . Job Address Lot Blk. Tract 4. Owner 5, Contractor - ' Phone 6. Address 7. City State 2ip 8. Building Type: Residential Commercial O Institutional ? 9. Work Description: New ? Add O Alter ? Repair•k 10. Describe 11. No. Fixtures Water Closet No. Fixtures Cess o i fi l/D ld Bath tubs p o ra n e Se tic Tank Lavatory p Softner Shower Wel I Kitchen Sink Urinal/Bidet Oiher Laundry Tray Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 464-6100 -s..? _i Receipt ' MECHANICAI PERMIT Permit No. CITY OF EAGAN Fee Fill in numbered spaces S/C Typs or Print Jegib/y Tot. t. Date 2. InsWllation Cost 3. Job Address r Lot ? Blk. Tract 4. Owner 5. Contractor ' - ' --'-' -"" Phone 6. Address 7. CitY State , ZiP 8. Building Type: Residential '§!? Commercial O Institutional ? ? 9. Work Description: New O Add ? Alter O Repair k 10. Describe 11. uel Type No. Equi{?ment 8TU - M. Ea. Forced Air No. Euuipment CFM Ai dli H Mfg. r an ng: Boilers Mfg. Mech. Exhaust Unit Heater Mfg. Other Air Cond. Mfg. Gas, Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-6100 CITY OF EAGAN Remarks ,,,,,,;,;,,,, Country Home Heights . 1 3 10 18300 010 03 State Eagan, MN 55121 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK 1968 • .33 30 PAID SEWERLATERAL , 72 2143.75 107.19 20 WATERMAIN ?F WATER LATERAL & Stu 1972 ? 20 WATER AREA n STORM SEW TRK 1984 495.00 33.00 15 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 300. 00 5524 3-27-72 BUILOING PEF. 20 117 3-67 sac 5524 3-27-72 PARK ; z BUILDING PERMIT N? 7043 Receipt # Te be wed fer FIE2E REPAIR Esf. Volue $20.000 Date_ rA-rym}wr 9R , 19JI1_ Site Address 2910 Burnside Avenue Erect ? Occuponcy R-3 Lot 1 Bixk 3 Sec/Sub. CbtlntrY HOM fle19htJdter ? Zoning R-1 10 i 8300 010 03 Repoir XX Fire Zone NA Parcel # l E t T f C Vn arge n ? ons . ype o rc Name J2.Txm JOI7i1SOI1 Move ? # Stories ; Address 2910 Bi1ri151de AVenUE - Demolish ? LengthN& b Ci Erlgan 55121 phone 454-3005 Gmde ? Depth--N?-_Sq. Ft.- ? Name Rill RYIIPS'*1P ApProrols Fees a ?? llddren 3729 Pilot Ki1ob FdUad ? P.... Faean 55122 e?___ Name _ Addrese 1 hereby acknowledge thot I have reod rhis applicotion ond state that fhe iniormafion is correct and ogree to comply with all ap0licabla $fate af Minnewta Statutes and Ciry of Eogon Ordirances. Sipncture of Pertnittee A Building Permie Is issued to: R? all work sholl be done in accordance wlth all Buflding Officiol CITY OF EAGAN 9793 Pllae Knob Road Eegan, MN SS122 PHON[s 451-8100 Assessmenl _ Water 8 Sew. Police - Fire Enp. Planner - Council _ Bldg. Off. _ APC - Permit 14o.7V Surchorge 10.50 Plan theck NA SAC im Wafer Conn. NA- Woter MeterNA, - Road Unit NA Tot,i $157_!1(1 on tha ezpress conditian thni of M{ nesQip Mutes and Ciry of Eagon Ordirwntes. r? ?.? ik 77 G? CITy pF FAGAN Include 2 sets of plans, 1 site plan w/elevations & BUILDING PERNIIT APPLICATION 1 set of energy calculations. 7b Be Used For c'- "Valuation Date Site Address `O OFFICE USE ONLY i,ot ? Block ?- Sec./Sub. C?f?P- ? -3 Erect Occupancy Parcel #: 10 l?-?-0 ?? C9 tU Alter zoning f Repairi - Fire Zone osmer: Enlar5e _TyAe of Const. Address: M°ve # Stories ft. ?, Deirolish Front City/Zip Caie: C?-*O-r\, SS? 2- ? Grade Depth ' ft. Phone #: y s q3 rp S FEEs Contractor: &0-1, ?A'f STG? AddmSS: 37 t y r- VH NoR v, citY/zip coae: Z-Z- Phone #: Arch./Eng.. Address: City/Zip Cocle: Phone #: APPROVAIS Assessnnents Pexmi t Water/Seaer Surcharge Police Plan Check Fire SAC glq, Water Conn. &14_ Planner Water Meter .OrA Council _ Road Unit 41^ Bldg. APC TO7'AL ?f? ` EAGAN TOWNSHIP BUILDING PERMIT Owner ...........\!f.!!ncrn.'.`.-?....?....-----------'-- O q ? Address (Present) .... °t:.[_L.G..._..'. .. ......".' ..................._.._ k? Builder ---------- /?..':?. ?....... Q3-" ."."' ° ..'. .......-- ............._ .. Addrese ......---_........-------------------- ............................ DESCRIPTION N? 1539 Eagan Township Town Hall Dafe ...... !_.....r?G 7...- .............. Siories To Be Used For Froni Depfh Heigh! Esf. CoaS Permi! Fee Aamarks ,ac=cc?C.-z`??- LOCATION SSreef, Road or oiher Descripiion of Locafion _I Lof Black ' Addifion or Trac! *?? /,r-? . This permif does not auihorize the use of siseeis, soads, alleys or sidewalks nor does it give the owner or his agenf the righifo ereafe anp siiua}ion which is a nuisance or whieh presenis a hazard !o the hea]!h, safefp, eonvenienee and ganeral welfare 1o anpone in the eommuniip. THIS PERMIT MUST BE KEPT ON HE PREMISE WHILE THE WORK IS IN PAOGR S? S. This ia !o cerlify, ihal..... ,......'- -" .............. ....'-.'-_............... has permission !o erec2 :?'""? /- q}?------.--.. -.•-- - upon the above deseribed pree su jee! to the provisions of the Building Ordinanee for Eagan Town ip aAh doppzil 11, 1955. /J? -_"'-"""-"---......--'......:'....._".`r_.Y....?.._-.."?....---. Per ........_............ Gl.?+-ea.o......-- ........ .............. of Tnwn Board 4 , B ?? r Bildin Ina ector ? Thig reqaest void 13 1e n,7=16.?6 CLI 1 B3, I?r,? . 4o<-A_(` fWi. t.?$Sq W sD,vl Reques[ Dete I ?_??, ?? Fire No. Rouqh-in Insoeciinn 9 ireA? ? - ?V?;s No ,?./ ?Readv Now ?gWilil ins pec' l N ot v. ? 1or When qeadY_ C] Licensed Electticnl Contractor I herehyrequest inspection of a6ova 0 Owfier electncal work installad at Street Address, Bou m Route Na. City tv /JnU ??? ? ??TO4? aclion o. Townshiv Name or No. Ranpe. No. County I7 Nv pecupnnt IPflWTI Phone No, sF? o?,? sa s,,. ys y- 3? 6 Powe{ Suoolier Address ?? EIG ?f?n cul Con trec ror (Cumpany Name) Cuntractnr"s License No. ( ? ] ? ^ l./ Mailir4q AtlJress I ConVacto, or Owner Makinq Instailatinnl _ p µ.rv\- `/ Authorized SiNnature (Cnntractor/Owner Makinq Installation) Phone Numbe.r?NNESOTA STAd£ BOAflD OF ELECTRICITY TMIS INSPECTION REQUEST WILL NOT Griggs-Midwav Blde. - Noom N-191 ' BE' ACCEPTED BY THE STATE eOABD 1821 UniversitV Ave.. St. Paul, MN 55104 UNLESS PFOPEfl INSPECTION FEE IS Phnnw 18121297-2111 ENCLOSED. /? ';REQUEST FOR ELECTRICAL INSPECTION p? ??, Seo instructions (or completing this form on bnck ot yellow copv. V " Below Work Covered by This Request EB-00001-03 Nev, Atld flep. Type of Builtling Applinnces Wiretl Equipment Wired Home Ranye Temporary Service Duplex Water Heater Lighting Fixtures Apt. Buildfng Dryer Electric Heatiii Commercial Bldy. Fumace Silo Unloader Indusb'ial Bldg. Air Conditioner Bulk Miik Tank Farm Othe.r peci v ?M1e? ISnecifyl thnr ISUecilY Othoi Othiqr Compute Inspection Fee Belaw N Fee ServiceEnhance$ize k Pe.e Feeders/Subieedars N Fea Circaits ? O ? 0to 100 qm 0s 0 to 30 Am ps 45,100 0 to 30 Am s 101 to 200 Amps 31 to 100 Amps 31 to 700 Am Above 2D0 Amps Above 100_Amps Ahove 100_Am)s Transrormers Remote Control Circ. Partial%Other F e Signs Special InsPection S 'G'tl ;? Feirvarks i TOTAL FEE ?j0. J Roueh-in Da?e ? j ?/?-J` 1,the Bechieal Inspector, Iiereby certify that the above inspectiOn has been C --?; j made. This request voitl 1 a mmo Ns hortr Thia request void ?$' 7664 RP.quCSt Uate Fire No. flouPi?-i0 InsPeclion Feqv ?e.d? ?Reatlv Now [] Will NoGfy.lns peo ? ..._ ?y ?s to r When Rr,udY n Licensed Eleculcal CunVar.tor I hereA re ' y quest mspec[ion ol above kwner electrical work installed at: SVeet Address, 6ox or Rnute No. ]? 1 r S / ' 7 Ciry ? °1 C c i?v? t !.' Ji,LI- 1 \ eciwn o. • Township N,?me or No. ftange. Nn. Counly Ixt-i/ _\'?../j ??(JT` Occopunt (PflINT) i:li`cyN?? 3c? ? rv SV ? Phonc Nc. ? ?`a ? -3GL!?? Power $voPlier ? 1 C .T J Aadress Etectrical ConVac[or (C omuuny Nxme) ' Cnntrar.me's License No. { ? ?.{.? Mailing AAJress (Con[ractor or Owner Mokinu Instailation) AWhonze.d Sfgnature (COntr tor/Owner Makine Installatiurd Phiinc Nmnber NNESOTA STAT AqD OF ELECTRICITY ' .. THIS INSPECTION REQUEST WILL NOT iggs-Mid'wey Bldg. - Noom Nd91 ' BE ACCEPTED BV THf STATE BOARO ' 1621 University Ave., St. Paul, MN 55704 .. ' . UNLESS PflOPEN INSVECTION FEE IS Phona 1612) 297-2111 ENCLOSEO. ^ AREQUEST FOR ELECTRICAL INSPECTION EB-00001-03 T i 7' I1. v •r O y? /?/ See instructions lor completing this form on bnck of Velluw cnpy. ,?'"X" Below Work Covered by Ihrs Request -:2 ; r.?s q l (O Ne AAd Rep. Type oi Builtling AoPlfances Wired Equipment Wired Home Ranye Temporary Service Duplex Water Hcater Lightiny Fixtures Apt. Building Dryer Electric Heatin Commercfal Bldy. Fumace Sllo Unloader Industrial Bldg. Air Conciitioner Bulk Miik Tank f-arm ??t", .tle"iW otne, 1SUer:ifv1 ihe r Sueci v. Other pther Conrpute lnsper,tion Fee Below d Pee SarviceEntranceSize U Frte Feede,s/SUblexAers # Fca Circvits Q100 0 to 100 qm s 0 to 30 Am>s 0 to 30 Am s 101 to 200 qmps 31 to 100 qinps 31 to 100 Am s Above 200 qmps A6ave 100_Amps Above 100_Amps Transtormers Remote Control Circ. '.? P rtial%Other Fee Signs Special Inspection , T A o R??narks OT L FE JO. J . J Rough-fn Date ?, ihe Elechical Inspector, hereby tif th h Fin;il cer y at t e »bove inspectionhasbeen __ - ..? _ ._.7 °? _ •.% metle. Thls request voi,1 18 nionths from 2007 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone 9 651-675-5675 FAX # 651-675-5694 New ConsWction Reouirements 3 registered site surveys showing sq. ft. of fot, sq, ft. of house; and all roofed areas (20 k macimum bt coveraqe aliowed) 1 Soils Report if proposed building is to 6e placed on disNrbed soil 2 copies af plan shovnrg 6eam & window sizes; poured found design, etc 1 set of Energy Calaiafions 3 copies of Tree Preservatian Plan if IM platted aRer 711193 Rim Joist Oetaii Opfions selec6on sheet (buildings with 3 or less unit) Minnegasco mechanical venGlation fortn Telephone #( Plans are considered pu6lic informafiion unless vou state they are trade secret and the reason. Date ;7 Constructian Cost Site Address `e AIV-t Unit/Ste # ? r Descriptiou of Work Zy f? Uf? Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2 ? ? ?J Property Owner ? Telephone # ( ) /,/'v ?(( -? I Cantractor P/ C O its?/?c.e.7`•-? ? Address T( '/ DO City Ah State Zip 6`?V? Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTitUCTING A NEW BUILDING - Minnesota Rules 7670 Catesorv 1 _ Minnesota Rules 7672 Energy Code Category , Residential Ventilation Calegory 1 Worksheet • New Energy Code Wor9csheet (Jsubmissiontype) Submitted Su6mitted . Energy Envelope Calculations Submittetl In ihe last 12 mon}hs, has the CiTy of Eagan issued a permit for a similar plan based on a master plan? ! Y. _ 4d if yes, date and address of master plan: Licensed Plumber Mechanical Contractor Sewer/Water Contractor I herebY apply for a Res Telephone #( Telephone # ( On-siteSeptlcSystem _Y _N Permit and acknowledge that the information is complete and accurat that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; 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. Lof.l?s.,? ?E?1-A??--?-. Applicant Printed Name 9? 15?6 RemodellReoair Reauirements Oifice Use Oniv 2 copies of plan shovnng foofings, beams, joists Cert of Survey Recd _ Y _ N 7 setof Energy Calculations forhealed addifions Sals Report Y _ N i site survey for additions & decks Tree PreS PladRecd Y _ N, Add"Aion - indicate iloasife sepfic sysfem Tree Pres Required Y _ N i ? App ic t ignaCure , EAGPN 1UWNSHIP 3795 Pilot Knoh Road St. Paul, Minnesota 55111 Telephone 454-5242 PERMIT FOR WATER SERVICE CONNECTION Date: March 27, 1972 Number: 797 J-3 Gf/?Billing Name: Jerame H. Johnson Owner: same Site Address: 2910 Burnside Ave., Eagan 55121 Billing tlddress Plumber• Weier)Rke Trenching & Excavating Met/er Size-? " Coanection Chg. 300.00 pd 3/27/72 Meter No??G9?1?a? Permit Fee ,??'• °'" ?a=/•?.:i Meter Reading f Meter Dep. 15.00 pd 3/27I72 Meter Sealed: Yea_ IAdd'1 Chg. NO [Total Chg. Building is a: Residence xx P4ultipie No, Commercial Iadustrial Other Inspected bq Date Remarks; ?,r ?, - •.. . ; ? ._ . I. . _ Sy: Chief Iaspector In consideration of the issue and delivery to me o£ the above permit, I hereby agree to do the pxoposed work in accordance with the rules aad regnlations of Eagan Township, Dakota County„ Minnesota. Sy: , ? Please notify the above office when ready for iss..pection and connectlon. EAGEN TOWNSHIP 3795 Pilot Krtob Road SL. Paul, Minnesota 55111 Telephone 454-5242 PSRMIT FOR SEWER SERVICB CONNECTION DATE: March 27, 1972 N[1MBER 9q9 r? OWNER: Jerome H. Johnson ,gddress 2910 Burnside Ave., Eagan55721 pLUMBER Weier*e Trenching & F,xcavafiffi OF PTPE Heavy Catt Iron AESCRIPTION OF BUILDING Industriall Commerciail Residential I Multiple Dwelling f No, of units xx Location of Connectiona: Connection Charge 260.00 pd 3/27/72 Acct. Dep. 75.00 pd 3I27/72 Permit Fee Street Repairs Total Inspected by: DaCe Remarka: Sy Chief Inspector In consideration oF the issue aad delivery to me of the above permit, I hereby agree Co do the proposed work in accordance with the rules and regulations of &agan Toc•mship, Dakota County, Minneaota By_ry??i? Please notify when ready for.inspection and cosu?ection and before any portion of the work is covered. ,lot For Office Use a~ I Permit#: I lty of Ea Permit Fee: 6 .d 3830 Pilot Knob Road I Eagan MN 55122 i Date Received: MAR 13 2009 Phone: (651) 675-5675 Fax: (651) 675-5694 Staff: - - - - - - - - - 2008 MECHANICAL PERMIT APPLICATION Date: Site Address: aq ~1~f18t ~V t Tenant: Suite RESIDENT / OWNER Name: 2pkor\, a- 4 Serom Ip_lrlSoYn Phone: (oS 30oS Address / City/Zip: 9A l0 ~v?rr15~ ~v e Ea- Ck» m P3 SS 12 CONTRACTOR Name: CENTERPOINT ENERGY License Address: 9320 EVERGREEN BLVD SUITE B City: COON RAPIDS State: MN zip: 55433 Phone: 763-757-6202 Contact Person: JOANN ZINKEN TYPE OF WORK New Replacement Additional Alteration Demolition Description of work: S"S_ a t\ i e i rt _ a. p .t NOTE: Both roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector or one of the Planners for information on permitted screening methods. PERMIT TYPE RESIDENTIAL COMMERCIAL Furnace New Construction Interior Improvement ?r Conditioner Install Piping Processed Air Exchanger Gas Exterior HVAC Unit * HVAC units must be screened Heat Pump r _ Under / Above ground Tank Install / - Remove) 'Other LX t wor When installing/removing tank(s), call for inspection by Fire Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR Contract Value $ x 1% $50.50 Minimum (includes State Surcharge) Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. If Permit Fee is > $1,000, surcharge increases by $.50 for each State Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). $ TOTAL FEE 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 witho t a permit; that the work will be in accorda ce with the approved plan in the case of work which requires a review and approval of plans. x JOANN ZINKEN x Applicant's Printed Name A licant's Signature FOR OFFICE USE I eviewed By: Date: Required Inspections: -Under Ground - Rough In Air Test -Gas Service Test In-floor Heat -Final For Office Use ' ter'-- tOl 7 rry� nYraY` E AGA N Permit#: Yw•w" r/I Permit Fee: (0 67 -ad Date Received: 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651)675-5675 I TDD: (651)454-8535 I FAX:(651)675-5694 Staff: buildinginspectionsCa?cityofeagan.com J 2019 RESIDENTIAL PLUMBING PER IT APPLICATIONf _ 1 9410 r s_d-c-M ss- Date I Site Address �V _Tenant: *0711:4 � Ng`� """ . '' f,, Suite#: �QF2esident/O .7- -, ! Name: �CI pk- Phone:6bl v d, IJ fU { f � ;i1: Address/City/Zip: P- I1 0eobi-P(4.4. friN-R---/ , ktr .11;c Name: MILBERT COMPANY dba CULLIGAN WATER License#: WC641376 Contractor. Address: 1801 50TH STREET EAST City: INVER GROVE HEIGHTS State: MN Zip: 55077 Phone: 651-451-2241 Contact: BILL MILBERT Email: gloria.abas@culligan4water.com Type of Work —New Replacement i Repair ^Rebuild _Modify Space _Work in R.O.W. Description of work: Water Heater Lawn Irrigation( RPZ/ PVB): y Water Softener DeScrlption Add Plumbing Fixtures( Main/_Lower Level) —Septic System Description: New Connection to City Water from Well Abandonment -- RESIDENTIAL FEES ;_.._._...__.._...___.__�.__....._._�_ � ._......._.._... $60.00 Water Heater,Water Softener, or Water Heater and Softener(includes State Surcharge) $60.00 Lawn Irrigation(includes State Surcharge) $60.00 New fixtures, adding or removing piping(includes State Surcharge) $60.00 Septic System Abandonment $100.00 New Residential (fee collected with Building Permit) $115.00 New Septic System (includes County fee and State Surcharge) $60.00 Connecting to City Water from Well* +$290 for Meter and$190 for Radio Read =$540 *Sewer&Water Permit also required for connection charges 60.00 TOTAL FEES CALL BEFORE YOU DIG. Call Gopher State Ono Call at(651)454.0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www,gopherstateonecail.ory You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.cityofeauan.comfsubscribo. 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 ♦ agan; 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 acco dance wi h the approved n In e ca of work wh' h requires a.review and approv I of pl•ns. X \�� ' �� x Applicant's Printed Name Applicant's Signature Page 1 of:2