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3779 Red Robin Lane For Office Use city of Faau Permit Permit Fee: ~~a 3830 Pilot Knob Road Eagan MN 55122 Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 Staff------------------- 2009 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: Z2~d I Site Address: 31 i 1 feed Rc491' (I Tenant: Suite Q RESIDENT / OWNER Name: ( )`SIG( 1 p ( Phone:Q -1 152-- 5 - / ~9 Address / City / Zip: CONTRACTOR Name: License 7 ?r_ Address: City: 3670 DOW 84.0100 State: Zip: Phone: Contact Person: TYPE OF WORK New V'Replac merit Repair Rebuild Modify Space Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Heater Water Softener Lawn Irrigation 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 $ 0 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 f 9 X ~S ?Au r Applicant's Printed Name Applicant,'s Si FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground _Rough-In Air Test __Gas Test Final A 110 Use BLUE or BLACK Ink For Office Use l City of Ea Permit#: I I Permit Fee: -7 3830 Pilot Knob Road I I 1 Date Received: 2 I`~ I Eagan MN 55122 I -k-- 1 Phone: (651) 675-5675 I Fax: (651) 675-5694 I Staff. t_----------------.1 2013 RESIDENTIAL BUILDING PERMIT APPLICATION its -13 Date; Site Address: 3_7 75 37-2 3 78'1 3785 b;•, ~4'ttUnit* ~ i Name: Phone; Resident/ iii Address / City / Zip: Owner ! Applicant is: Owner Contractor ,i @ 0 o Description of work: C?ca ` -,D e Construction Cost: ' 1 5 0 0 Multi-Family Building: (Yes / No { Company: ~~~°1o~n~¢\c ~r t~ ftoJuca~-, Contact: 4'- 1 Qf 1 Address: f~ Cantractar 2' ~t a Z)r, City: ;State: M Zip: Phone: J `'1 15 - c~ ?Oro l License ~ - )~iP ibq 5 Lead Certificate P7_ - ;10(yo'~ " l If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the fast 12 months, has the City of 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. Plans and supporting documents that you submit are considered to he public Information. Portions of i the information may be classified as non-public if you provide specific reasons that would permit the City to I---- conclude that tare trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Cali 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 approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuancce.? X J0.r I I7~,c~~*~~' X s-'~if~ Applicant's Printed Name Applicant's Signature Page 1 of 3