756 Lasso Lane
Use BLUE or BLACK Ink
~ i or Office Use ~
Cat of Ea ~n Permit V T
eJ
a1 ti Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 j Date Received: j
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I I
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 1 dJ-dI~ ) Site Address:_"7~C?
Tenant: A 1"1ay C 'e_V"-' ,Y- Suite
RESIDENT / OWNER Name: h(W-1c,~ y~°~ (fit' (Yl T( Phone W ~ `0('18°5° ~n I
Address / City / Zip:
Applicant is: Owner _,~CContractor
TYPE OF WORK Description of work:
ConstructionCost. Multi-Family Building: (Yes / No )
CONTRACTOR Name: ~ r J~TI~G ,~~~~(7 116 License
, bbl N(=72
Address: 7/ V~Co City:
State: f /,y Zip: V Phone: `7` 1 0
Contact: k_ Email: ofiuryhuir't -nct
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 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,fo be public information, Portions of
the information maybe classd as non-public if you provide specific reasons that would permit the City to
cor►clude'that the are fiadesecrets.
CALL BEFORE YOU DIG. Call Gopher State One 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.gopherstateonecall.orq
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.
Applice • is Printed Name Applican 's Signature
Page 1 of 2
Use BLUE or BLACK Ink
r
For Office. USP
Permit / s
Ab~ City of Ea
b I Permit Fee:
3830 Pilot Knob Road I
Eagan MN 55122 Date Received: I
Phone: (651) 675-5675 I 1
Fax: (651) 675-5694 1 Staff: / -
2010 SEWER AND WATER REPAIR / DISCONNECT PERMIT
Date: C~ 12- - 2o 142 Fee: $55.00
City Sewer City Water Repair Disconnect
Description Of Work:
re
Street Address for Proposed Work`
. Name: '60- /94~-L Phone4kk 97'ejCsj;-' Z24 Z
OWNER
Address/ Cit
/Zi
Applicant is: Owner -2(- Contractor
Licensed Pipelayer Master Plumber Property Owner
Name: i /Phone: 2 o
Address / City/ Zip: ~
Pipelayer Training Certification Card or Master Plumber License ~Z q3j
I acknowledge that the information is complete and accurate and 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.
Applicant (Print Name) pplicant's Signature
CALL BEFORE YOU DIG. Call Gopher State One 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.gopherstateonecall.org
CITY OF EAGAN Remarks
Addition Saddlehorn Lot 5 Bik 1
e??e.Le Street 755 LaSSO Lane
r MN
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF.S` Imp. 1981 1944.00 97.20 20
STREET RESTOfl. Q 19$1 1210.00 60.$0 20
GRADING
SANSEW TRUNK (, g 198 1 28 O,OO 14.00 ZO
SEWERLATERAL 19$ 3359.51 167.98 20
WATERMAIN
WATER LATERAL
WATER AREA `j ZJSZ 80.00 1.0 0 ZO
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
gUILDING PER.
sac 10470 4-25-74
PARK
CASH RECElPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
RECEIVED
FROM
AMOUNT $
& DOLLARS
?oe
? CASH F-1 CHECK
FOR
BY
Thank You
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number: '
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
;,... „ ,
SITE ADDRESS: APPLICANT:
1 r1Nt
PERMIT SUBTYPE: TYPE OF WORK:
, aan
t,. & f? r A oz,f
I INSPECTION .. . D•
,,
Permit Holder Date Telephone #
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
uti
ROUGH
PLUM8ING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVIN
TEST
HVDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN
8795 Pibt Knob Road Ea9on, MN 55722 N4 4955
PNONE: 454-8100
BUILDING PERMIT RecetPt # -
10. 6•_up.:ls t ?8
To be und For F Est. Value Dote , 19-
Site Address Erect [`J Occupancy
Lot Block I SCC/SUb. ;,,j`j1*Iter ? Zoning
Parcel # Repair ? Fire Zone
Enlarpe ? Type of Const.
rc Name Move ? # Stories
W
; Address Demolish ? Front fr.
b
Ci Phone 45.2 -3488 Grade ? Depth ft.
s'?.e7.n ,017st:. CO. APProvals Fees
,o Nume
ou Address <?`+54i a}2ata fllvd_
" _?46-3":,?
o?... .. a ` ?
r i-:... ' . .Nome
Address
I hereby acknowledge that I have read this opplication and state that
the informotion is correct and ogree to comply with all applicable
SMte of Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee _
A Building Permit is issued
all work sholl be done in a
Building Officiol
Assessment
Water & Sew. _
Police
Fire
Eng.
Planner
Countil
Bldg. Off.
APC
Permit ? - 0()
Surcharge ?' - 5 0
Plan check
SAC
Wnter Conn.
Water Meter
Tornl 50
1111-1 •' - on the express condition that
applicable State of Minnesota Statutes and City of Eugan Ordinances.
PannM # DaM lauad FasMho
I
Plumbing
-
Mechanical
INSPECTIONS DATE INSP. Roueh-In Final
Footings Data Insp. Date Irup.
Foundation Plumbing
Frame / ins. Mechanical
Finol 9 ? .
Remorks:
CI?Y OF EAGAN
3743 Pilot Kno6 Road
Eagan, MN 55122
Zoning:
Owner;
Address:
$ite Address:
Plumb
er•
.
? a9f" ro eomply with the Cify of Eagan
Ordinanees.
By
Date of Insp.:
I nso.:-
SEVNER SERVICE PERMIT
PERMIT NO.:
DATE: -
No. of Units:
Pilot Knab Road
MN 55122
Connection Chorge:
Account Deposit: _
Permit Fee:
Surcharge:
Misc. Charges: _
Totol:
WATER SERVICE PERMIT
PERMIT NO.:
DATE:
- No. of Units:
?
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: A
t D
cwun
eposit:
Reoder No.: Permit Fee:
1 agree to eomply with tha City of Eagan Surcharge:
Ordinaneea. Misc. Charges:
Tota I:
BY Date Paid:
Date of Insp.: Inso.:-_ _
cInr oF E.scaN
8795 Pilot Keo6 Road Eagaa, MN 55122 N2 4955
` PHONE: 454-8100 `,?,,
BUILDIPlG PERMIT APPLICATION ReceiPt .# ?-
To be uted for Garage Esr. vaiue $59000. DOYe August 28 Iq 78
Site Address 755 Lasso Erect ? Occuponcy
Lot 5? Block } Sec/Sub. S-aa+-+---n Add{ljlter ? Zoning
parcel # Repoir ? Fire Zone
Enlur9e ? Type of Const. V
W Name A11An Flt2 Move ? # Stories
o Address ]§§ Lgg9e_0 1-n Demolish ? Front ft.
Ci Phone 459-4L488 Grode ? Depth ft.
? Name Western Const, Co. APPro.ats Fees
,o
?? Address 6950 Wayzata Blvd
P Ci MDIs Phone 546-3385
GW Name
f
_M Address
I hereby ocknowledge that i have recd this opplication and stote that
the informotion is correct and agree to comply with oIl applicoble
Stote of Minnesota Statutes and City of Eagan Ordfnances.
Signature ot Pertnittee
A Building Permit is issued
oll work sholl be done in
Building Officiol
Assessment _
Water & Sew.
Police
Fire
Eng.
Planner _
Council -
Bidg. Off. -
APG
Permit 1 A - (1Q
$urcharge ? - SO
Plan check
SAC
Water Conn.
Water MeMr
Totai ?0 _ 5(1
Western Const. Co, on the express condition that
I applicable State of Minnesota Statutes and Ctty of Eagon Ordinances.
CTTY OF EAGl'?N
3795 Pilot Knob F.aad
Eagsx:, t•linnesota 55122
PFRMIT NO.: gg,c 40
The City of Eagan hereby grants to wenzel Pivmbing A xeati*±g?.
?f 3600 1Lnnekier Drive
d pr.TiMnrttr, Permit for: (Owner) H. RirckLneY Construction
at 755 rasao , pursuant to application dated 6/13/74
Fee Paido 62n_nn dated this 2Ath day of June , 19 7A +
.50 s/c
Building Inspector
Mechanical Permits:
Bid Total:
?- /- /
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
PERNiIT NO.: 611
The City of Eagan hereby grants to comniote tteaL-ing h"_rchalical Pe.rmits:
Bid Tatal:
3
Sc.?%j,? hvrv)
..5-'1/- /
.
c=1 or, EacAN
3795 Pi1ot xnoo Ptoad
Eaga;:, Minnesota 55122
PEFMIT NO.: 194
The City of Eagan hereby grants to Katz- Iton Kisl.ina
of
dsaP tic & nrnfld . Permit for: (Owner) Kirchner
at 755 Lasso ? pursuant to application dated 7/15/74 .
Fee Paida e7p,pp dated this 15 day of Julv ? 19 74 e
.50 s/c
Building Inspector
Pdechanical Permits:
Ilid Total:
5?.?(l?norr?
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
PERP•'1IT NO.:-
The City of Eagan hereby grants to Ri asnn t,TPi i r'o-
of $Fnn XpnnPhar--nri.m
a wFrr. Permit for: (Owner) xirchaer?'ong++-+•ction
at 755 zassQ , pursuant to application dated 6174
Fee Paid: , 49 S1Q,00 dated this 17th day of 7„?Ue _ ,.
.SO s/c
Building Inspactor• ?
N;achsnical Permits:
B::d Totals
?
CITY of EAGAN
BUILDING PEIaNIfT
owae: .......................... dl.t?.?
............ .. .. ...... ........ .......•-°---...-°----•--•
-
Addrass (preaeni) t:"
.. ••° --° ........................... ..• • -----.-..........................
f/
Suilder
Addresa
...............
DESCRIPTiON
siim
N° 3256
3795 Pilof Knob Road
Eagan, Minneso3a 55122
454-8100
a¦ta ..:yY
...... .--• .................
5tories To Be Used For Fron! Deplh Heigh! Ect. Cosi Pe:mii Fee Aemarka
I
?
? -a 6.?: "
?o, v? /d f _
ve- 3m:?
LOCATiON 73. azJ
Slreet, ttoaa or oiher neeeript3on o! Location I Lo! Slock ACelifion or Trae!
This permit does -not autharize the use of streeis, roads, alleys or sidewalke nor does it give the owner or his agent
the righ! 3o creale any siSUation which is a nuisance or which presents a haaard !o the heal2h, safely, convenience end
general welfare !o aayone in the communi2y.
THIS PERMIT MUST BE KEPTO?N? ?T?HE PAEMISE WHILE THE WOAK IS IN PAOGRESS.
This is to eeriify. !hal----....... .................. -..has pe:missioa !o erec! ?:,`.''..... ...................... _upoa
the above described premise subjeci io the provisions of all applicable Ordinances for 3he Cifp of Eaga
..:......-1?---°.`"-?--J-.-- ...................... -------- Per ..............------.-----.--..?`?.ee._....:?.`.?°:.-?•-•.._...............
-•••• ................. . Mayor? Suilding Inspector
!-'
czrv OF !_nra?
r.:aSH.r.ERe s TI-f;MIN(1L Nt7: 936
BFlTEe 09/02/38 TIMf": 15a52dk0
IL+:
NAME o JE.NN:I:FE::fi i_UF S'C AD
32i.C? 9001 755 I_.NtaSO I...N 48e50
205 9001 755 L..A$SO L..P! 0.75
To•h,al Fiece:ipt Amaunta 49<25
CFi!796E364
USE:k .T.D: NANCY
? CITY OF EAGAN
E830`Pi(ot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.I.N.: 10-65800-050-01
FERMIT
755 LAS50 LANE
LOT: 5 BLOCKs 1
SADDLE HORN
PERMITTYPE: susLozNG
Permit Number: 033101
Date Issued: 09/02 f g g
DESCRIPTION:
B
T.O. &
J?r;NPermit Type
1 i?d-rk, TYPe
:oCld';
?p.?.
. ,. . ...-a
RERpQF
y
an su
? .a
?
Gi?
? j,,.
,x<
SF (MISC.}
REPAIR
494 flLT. RESTDENTIAL
„ t
+?a
m »Q &o-r.a
?-."?.-11
3F, ' ?A? ? ? Ya
REMARKS:
FEESUMMARY: vaLUflTZON $1,500
Base Fee g48,50
Surcharge ? - 75
Total Fee $49_25
CONTRACTOR:
.
OWNER:
LOFSTAD
755 LA
EAGAN
(651)905-3928
Applicant -
ERIC
SSO LRNE
MN 55123
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOB RD - 55122
681-4675
New Construction Reauirements
? 3 registered site surveys
? 2 copies ot plans (inGude beam 8 window s¢es; poured fnd. design; etc.)
? 1 energy wlculations ? 3 copies of tree preservation plan i( lot platted after 7/1/93
required: _ Yes _ No
DATE: 17-t T ? ?
Name: `o?S?aO' F/'ic Phone#:
Last First
DESCRIPTION OF WORK: +Par 0`F,F , aN, 0,11- on /IPw /'dd`f
STREETADDRESS: 75a LqsSV Lorne r
LOT: r? BLOCK: k SUBO./P.I.D. S c<?'? V?? (,'L-
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
StreetAddress: 7.55 L?e55Q Lahe
Ciry State: M)V Zip:
Company: ae- / tp Phone #:
Street Address: License #
City
RemodeVReoair Requirements ? Cy
? 2 copies oi plan q`? b
• 2 sfte surveys (exterior additions & decks)
? 7 energy pleulations for heated addRions
CONSTRUCTION COST; i f S m
State:
Company: Phone #: _
Name: Registration #:
Zip:
SSla3
Street Address:
City
State:
Zip:
Sewer 8 water licensed plumber (new construction only): . Penalry applies when address chang
and lot change is requested once permit is issued.
I fiereby acknowledge that I have read this applipGon and state that the information is correct and agree to comply with all applicabl
Siate of Minnesota Statutes and City of Eagan Ordinanaes.
?
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preseroation Ptan Received _ Yes _ No _ Not Required
?
(612) 6814675
PLEASE COMPLETE FOR SINGLE FAMII.Y DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED kOR EACH UNTT.
NEW CONSTRUCTION ? ?
ADD-ON A/C / (,?t
ADD-ON FURNACE ? U''
DATE io- ;-?7- 23
?
FEES
HVAC: 0-100 M BTU $ 24.00
ADDITIONAL 50 M BTU 6.00
vA' i vu i iE, TS (Miiviiviuri i L a3.uii E A c:H)
ADD-ON/REMODEL (EXISTING CONSTRUCT1oN) $ 15.00
STATE SURCHARGE .50
TOTAL
?
SITE ADDRESS: rI S;!r ?QSS O ?N o
OWNER NAME: Z-, TELEPHONE #:
INSTALLER:
ADDRESS:
CITY: (?, STATE: ZIP CODE:
TELEPHONE #:
?-?
yzz?
SI ATURE OF PE EE
1993 MECHANICAL PERNIIT (RESIDEIVTTAL)
CITY OF EAGAN
3530 PILO'T KNOB RD
EAGAN MN 55122
MASTER CARD
LOCATION 4015so ,C„ . 7.,es ,.r-/ • Jrowhp rr•
OWNER
STRUCTURE AND =?
LAND USED AS ?
Permit
No.
Issued Issued To
Coniractor Owner
BUILDING
<a ,{l"
PLUMBING
ARE
CESSPOOL - SEPTIC TANK %
WELL .
ELEC7RICAL
HEATING ?
GAS INSTALLING
SANITARY SEWER
OTHER I
OTHER
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING SEPTIC
FOUNDATION ! . P CESSPOOL {U
FRAMING TILE FIELD FT.
FINAL
ELECTRICAL
HEATING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIEID
PLUMBI NG
WELL
SANITARY SEWER ?
Violations Noted
on Back
COMMENTS:
x
Date:
BUILOrt?G PF_fLtiilT P.PPLSCATIO?'1
z.aT ? sLocx ? ADDZTIo,"T
SFCTIOIS I3UP-113ER IF UtIPLATTTsD? ? _ ..
?
Gi P:°.:.CEL /C'%[ 4! e
OCCUPAAICY
. .. .a.,',T.) ?.O`j?i'
r.?
'PELEPAOVE 110.4Ai-"? - ??--
7,i .)??2 .SS'O (Gc Y1 (° _.
COi:?'z R'?C x C R ?.1? ?.: y? 'F fVl TELEPHONE ,TO .
N)TYRESS l9 ???o
Nutes Include site plen, building plans, and energy calculations v?_ th?.^
application ?--?
Sianed ,.?
OFFICE USE
JALUIITIOI?
..,,
''ic'2
'7JIT,D3PTG PEF2I4I2' FEE
^+J?1?'N*.RGE FEF.
11I.:t1Pi Cc:PCIt FE;
PAFiIZ DEDICATIO?T FEE
OR': uR
: n,.,T,,yr ti!
_e
----
a-?
?? ? ..
.??
?
` <? 3,5Sir1;:,'iAIT CLERK BUILDING DE?T.
USE
PQLICE DEPT.
E SEidL';R DEPT. FIAn Dr-P2'. PARK DEPT.
"155-Lasso Lane
Al1an Fitz
452-3488
24X26-Detached garage
2"=Insulation Sheathing
$XXX 12"-Bl?YSIDE MASONITE S
Hip roof w 127-Eaves ,
-Plywood roof %
#15-1b felt j
i/
#240-shingles
4"-cement floor 2'
#6X6X10-PJlesh
#3500-1b cement
/A
1 X 4 BRACE
,
? _;.....:
1 . fi qOQF BRAi;ING
.j
X 6 TtES
X
It'2 X 4 GABLE STUDS 76'" O C
i ?
?
\ 1! I I li ? ? f II I (? I ?? I I? I I? ? ? DUUBLE 2 x 12 OVER EAD
, i ?? DUOR HEADE?? 1NtTH?" G1b7
1N.qTION
\\ I l I I I? I 4II I U61 F 7nP P i TE J/
I II I Ii
2 X 4 DOUOLE DOOR SrUUS i
• ?? 5 7 D S 16" O C I ?
?
.?
16 ?
?OUBLE CORNERS
I
WESTERN CONSTRUCTION C0.
TREATED- 2 X 4 SINGLE BOTfOM PU qTE fRpNi BOTrOM PLATF 6950 WAYZATA-qOKEVARD
MINNEAPOLIS, M1k:'-55426
, •? ..
Page 2 of Pages
DATE
(
DESIGNED FOR: + 1 ? ki Z-
ADDRESS: M h ?
THIS PLAN ACCEPTED BY:
LEGAL LOT.
d lA /i /t// ! ./ r
16:27 APR 19, 1997 ID: DRKOTA COUNTY TEL N0: 4388516 #13906 PAGE:
? ?- v'
Municipal Notice of Well Permit Application
Dakota County Environmental Managemem Departmerrt
Water and Land Managemeat Sectioa
14955 Galaxie Avenue West
Apple Valley, MN 55124
Tel(612)891-7011 Fax(612)891-7031
DATE: Apri! 10, 1997
T0: Tom ColbertlWavne Schwanz
FROM: Water and T,and Management
RE: WeII Permit #: 97-H115091
Municipality; Eagan
Fax #; (612) 6814612
Well Type: Sealed
Envirommental Speciaiist: Demuth
Tle Water and I,and Nlanagement Section of the Dalcota County Environmental Management Department
has received the follo«ring pern?it applicatiwi for the well described. If you require further review of the
application or if you have any questions or cancerns ahout it, contact the Enviromnental Specialist listed above
or our offic:e at (612) 391-7011. [f there is no response from your office within 24 HOURS (excluding
weekends and holidays), we imiIl assume that you have no objections to the issuance of the permit. Please note
t6at permit issuance is always conditioned an the permit applicaat's observance of and complianct with all
applicabie state, county, and municipal laws and codes.
WeII Contractor: Harbnann Well Campany
Date applicaticm received: March 24, 1997
Arnicipated Drilling Date: / /_ Time: • -
Anticipated Groutmg Date: Apri1 10, 1947 Tune: 10:00f#M
Properiy Owner: SalIy Fitz
WelI Owner: Sally Fitz
WELL LOCATION:
PLS Coordinates: 1/4, sw 1/4, ne 1/4, nw 1/4, Sec 25, Town 27, Range 23
Street address: 755Lasso Lane
PIN Niunber: 10-65800-050-01
WELL INFORMA'ITON:
Diameter: 4
Casing depth: 390
Total depth: 345
Static Water Lcvel: 155
Aqaifer: Unconsolidated Sediments
COMIvIENTS:
v 6 ?X
? 1-3 VA v
R°97Y DAKOTA COUNTY 04-10-97 04:29PM P001 #21
;?? ?
?
0
?
?
For Office Use
Permit#: �� �
P i V
�.y kw .mf .,d
.�,�.- .*�..� E AG AN (D4e•-•
Permit Fee:
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694L Staff:
buildinuinspectionsCc�cityofeagan.com
2018 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 1,1;'-it I -1 ` Site Address: Liss b L ..-i ..
Tenant: Suite#
`"
TName:
Phone:
I Resident/Owner
) Address/City/Zip:
,-f- p c' t.. 1- it,11 t1 % C & -N
Name: � pa-,..-L--(2 License#: �
Address: .-r , -- l e.,...2:--17;/ City: l; .-tp 'Z.-IPS
Contractor ` e� /
I/ Zip: ' ..:„1":7/27.— Phone: / 'ff� 737
; State:
Contact: Email:
) New V1�eplacement _Repair Rebuild Modify Space Work in R.O.W.
Type of Work i —
c
L /
I I
Description of work:
...._ ...RESIDENTIAL.� g ..0
(
Ii - " Water Heater '
t ,Water Softener
Lawn Irrigation(_RPZ/ PVB) ,
Permit Type ' ", Add Plumbing Fixtures( Main/_Lower Level)
Septic System ;�°
iWater Turnaround
_New
Abandonment t
i RESIDENTIAL FEES:
4� $60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
1 $60.00 Lawn Irrigation(includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Turnaround*(includes State Surcharge)
i *Water Turnaround (add$280.00 if a 3/4"meter is required)
$115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES $
CALL BEFORE YOU DIG. Call Gopher State One 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.aopherstateonecall.orq
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.citvofeauan.com/subscribe.
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 with.ut 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 44\1,et L4
'€ ' x
Applicant's Printe ame A.p an' nature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
Meter Related Items: Meter Size Radio Read Manometer Staff: