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.
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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*
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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
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