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4140 Lexington Ave Use BLUE or BLACK Ink I-----------------1 i For Office U& I Permit 1 ce of fly Eapn I Permit Fee: 3830 Pilot Knob Road Eagan MN 55122 I Date Received: i Phone: (651) 675-5675 i I I StFax: (651) 675-5694 - 2010 COMMERCIAL PLUMBING PERMIT,,APPLICATION Date: p ~ site add Tenant: 7c //S 24 ts Suite PROPERTY OWNER Name: AW /,O~J Z4 S Pho 1'"~ ''~(J.JI J . ID)yea" CONTRACTOR Name: If/1 License 00, Address: City: State Zip: y/ I !°~C!/I~l~,~ Coy I/ 1 Phone l r Email: TYPE OF _ New ` Rep came _ Re air Rebuild _ Modify Space _Work in R.O.W. WORK Description of work: PERMIT TYPE COMMERCIAL _ New Construction Modify Space _ Irrigation System yes no) RPZ PVB) • Rain sensors required on irrigation systems • Avg. GPM (2" turbo required unless smaller size allowed by Public Works) Meters Call (651) 675-5646 to verity that tests passed prior to picking up meter. Domestic: Size & Type Fire: 1 Avg. GPM High demand devices? Yes _No Flushometers _Yes _,,,_No COMMERCIAL FEES: $50.50 Minimum (includes State Surcharge) OR Contract Value $ 6 X1% = $ Permit Fee Required on ALL new buildings and boulevard irrigation systems _ $ Radio Meter Read - If Permit Egg is less than $1,000, surcharge is $.50 = $ Meter(s) - If Permit a is > $1,000, surcharge increases by $.50 for each $1,000 $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). _ $ LQ State Surcharge Following fees apply when installing a new lawn irrigation system. $ Water Permit Call the City's Engineering Department, (651) 675-5646, for required fee amounts. $ Treatment Plant $ Water Supply & Storage $ State Surcharge TOTAL FEES _42. 6-0 CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 464-0042 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.aooherstateonecali.org 1 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 wi ut a permik that t rk will be in accordance with the approved plan in the of workyApich requires a review and approval of plans. X x Applic n ntted Name Applicant's Signature FOR OFFICE USE Approved By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final PRV Required: _ Yes No Page 1 of 3 ? K?*( . • ",-w ?,. -?. . ... .?:tl r '`ry . .. . . .. . .. .. . M -n ?`.?-.. ... . . . .. L ..::. 1" . y PERMIT # /? J L MECHANICAL PERMIT RECEIPT # ?77 F ' 3830 3-t' CITY O EAGAN PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE: PHONE: 454-8100 Site Address - Z " _ BLDG. TYPE WORK DEtPRIPTION Lot Block I _ Sec/Sub ? Res. New ? ? - 2 Mult. ? Add-on Name . - > Comm. Repair m Address c Ciry i 11 /.• g.. c.? Phone Other FEES Name - r - RES HVAC 0 100 M BTU (D . - -$24.00 3 Address ADDITIONAL 50 M BTU - 6.00 O CitY -L f) c ricy-y ? Phone RES. HVAC INCLUDES A/C ON NEW - CONSTRUCTION) GAS OUTLETS M ( INIMUM - 1 PER PERMIT) - 1.50 EA. ' TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE Forced Air M BTU APT. BLDGS. - COMM. RATE APPLIES 1 Boiler i3GL M BTU TOWNHOUSE & CONDOS - RES. RATE APPUES , MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8 Unit Heater M BTU REMODELS - 12.00 ° Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00 ' Vent. CFM $ STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES ; Gas Piping Outlets # R BEYOND $1,000) ? Other g FEE: 1.? v ! I ? ?-.?t I..' -+? ? ?V S/C: ? SIGNATURVOF-PERMITTEE ' TOTAL: 1 ' _ FOR: CITY OF EAGAfV . • ? „ ' PERMIT # 4F?3 61 ?f ' • • PLUMBING PERMIT 7?0 CITY RECEIPT # I OF EAGAN .7 3830 PILOT KNOB ROAD MN 122 EAGAN , , 55 DATE: ? I CONTRACT PRICE PHONE: 454-8100 Site Address BLDG. TYPE WORK DESCRIPTION i Lot Block §ec/Sub Res. New Mult. Add-on ? Name Comm. Repair I Fq Address ` Other N c ? w O ? Ci ` Ph one ?Y . LLOWING RES PLBG ONLY - COMPLETE THE FO G Kd . . NO. FIXTURES TOTAL Name ? -Water Closet - $3.00 S m _Bath Tubs - $300 Address ` 3 3 J _Lavatory - $ .00 O City, - ?.. - - • 4 Phone _Shower - $3.00 7 !/ -Ki?chen Sink - $3.00 FEES -Urinal/Bidet - $3.00 COMM/IND FEE - 1% OF CONTRACT FEE -Laundry Tray - $3.00 APT. BLDGS - COMM RATE APPLIES -Floor Drains -$1.50 TQWNHOUSE R CONDO - RES. RATE APPLIES -Water Heater -$t 50 MINIMUM - RESIDENTIAL FEE - $12.00 -Whiripool - $3.00 MINIMUM - COMM/IND FEE -$20.00 -Gas Piping Outlets -$1.50 STATE SURCHARGE PER PERMIT - 50 (MINIMUM - 1 PER PERMIT) (ADD $.50 S/C IF PERMIT PRICE GOES -Softener -$5.00 BEYOND $1,000.00) -Well - $10.00 _Private Disp. - $10.00 - ? ? `--? _Rough Openings - $1.50 -j ltt , L FEE SIGNATURE OF.pERMITTEE : STATE S/C: FOR: CITY OF EAGAN GRAND TOTAL: ?-? `<' (?/??REQUEST FOR ELECTRICAL INSPECTION ? Es-oooot-os J r/ ? See instructions lor completirg this form on beck o1 vellow copy. /_S1le7l D - U 5,1 ! "X" Below Work Covered by 7his Request N Add Nep. Type ot Builtling ApDliaaces Wired Equipment Wired Ik M Fee ServiceEnlrenceSize H Fee Peeders/Subfeede,s ++ Fee Circurts 3.eo U to 200 qm s 0 to 30 Am s 1 ' 0 to 30 Am s Above 200 qmps 31 to 100 Amps y 7p- 31 to 100 A 5 Swinxning Pool Above 100_Amps Above 100_Amps Transformers Irrigation Booms •SO PartiaLOther Fee Sigis Specfal Inspection USQ• TOTAL F flerrNrks Su Fouph-in ne 1, the Electriwl Inspector, hereby c Gl th t th b Final Dx-e I er y e e a ove insvection has baen • ?'?.?/' 7 mede. (nis request vold 18 momha Irom ? . C -- - - ' CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ? PHON E: 454-8100 BUILpING PERMIT Receiptx To be used for Est Value ' Date 119 Site Address OFFIC E USE ONLY Lot Block Sec/Sub. On Site Sewage _ Occupancy MWCC System _ Zoning Parcel No. " On Site Well _ 7ype ot Const - ` Cit Water (Actual) a Name y _ (Allowable) W z ; Address # of Stories Length 0 Clty PhOne i Depth S F Total , p Name . . Footprint S.F. ?` Address APPROVALS FEES cc City PhOne Assessments sJ Permit ? a V Water/Sewer _ Surcharge c y j W N8R16 Police _ Plan Review ~ Z x - n Address Fire SAC, City - o aW City Phone Engc Pl SAC, MWCC W anner _ aterConn. I hereby acknowledge that I have read this application and state Council Bldg. Off. _ Water Meter _ Roed Unit thattheinformetioniscorrectandagreetocomplywithallapplicable APC _ TreatmentPt State of Minnesota Statutes and CRy of Eagan Ordinances. Variance _ Parks Si f Copiea ' gnature o Permittee TOTAL A Building Permit is issued to: on the expresa condition that all work shall be done in accordance with all applicable State of Minnesota St t t d Cit f E O di Builciinn nffirial a u es a n agan r y a nancea Psrmit No. Permit Holder Dats Talophons X Plumbing j _ r _ ="? ;,' 1 /, , ,. ; /'?•; ;? ? H.v.aa ?. Electric ?, `- Softener Inspectlon Date Inap. Commants Footings I Footings II Foundatlon Framing ? Roofing Rough Plbg. Rough Htg. - z- 4? AM' jwv Isul. ?-;z ^c' Fireplace ;,fp/K Final Htg. -?y wvA Tb r-,L- 9-?- d'7 Final Plbg. ? Bldg. Final Cert.Occ. Temp. LP Deck Ftg. Deck Frmg. Well /a -/3 -87 Pr. Diap. ???02 J-? ??6? uy "/z?` OF EAGAN SEWER SERVICE PERMIT Pilot Knob Road Box 21199 9:+n 1 PERMIT NO.: in, MN 55421 DATE: f?- 9- t' 7 i9: g4 No. of Unib: ??* ;r Z Partners Plumber to comply wHh the CNy ol Eagan of Insp.: ? CITY OF EAGAN Permit No:_ 3830 Pilot Knob Road Meter No: _ P.O. Box 27199 Reader No: Eageo, MN 55421 8807 Connection Charge: Account Deposit: - Permit Fee: Surcharge: Misc. Charges: - Total: Date Paid: Owner. Fi 8 Z Partneis ? Date: Size: Date: 1, 6-9-87 ' SiteAddress:- _4140 LeYinQ ton ilvenue LL Ll_ Lt')..il:-to.. ;'ills Plumber. J. B• RBUr'e l Conn. Chg: ?0- 080. Ollpd Zoning: 74 Acct Dep: No. of Units: 24 Permit Fee: 10• 00Dd Surcharge: • 50pd 1 agree to comply with the CHy of Eagan Tr.Plant ? 456.00p'': Ordioances. Meter. Misc.: By inis request void '^ 1+?, 19 mon(hs from ? N'? 8 -7 D8 517,1 w P/ ,;',/', °D RequeStDate- ? _• F g h-n InsPection Required? []Ready Now ZWill Nmify Inspec- Odyes ?No . , tor When Ready ? Licensed Elec2rical Contractor 1 heraby request inspectfon of above ? Owner electrical work installed at: Street Address, Box or Route No. Cfty ? //t1 oN P.?J 9 i¢rJ ecuon o. Township N?me or No. Rangc No. County ?,l/nTG' ON !7/LL? !!T T5 Occupent (PRINT) I/ Phune No. Power SupDlier Address .4 D G,?G G /itJ Electrical Contractor ICompany Name) Contractor's Lir.ense No. /1??s?2 r.?:G Dya7 ?3 Mailing AdJress IContractor or Owner Making Instailationl i. /? r?G ? ?? Authorized Sign ure (Contrector?Owner Maki g Ins[allation) Phone Number $o -s MINNESOTA STATE BOARD OF UECTRICITY THIS INSPECTION NEQUEST WILL NOT Griggs-Midway Bldg. - Room N•191 - BE ACCEPTED BY THE STATE BOAPD 7821 Univarsitv Ave.. St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. 24 UNIT.M. D BUItDING PERMIT 9 To ba used for APT/GAR Receipt # G Est.Value $500,000 Date MARCH 0 19 87 SiteAddress 4140 LEXINGTON AVENliE Lot 8 Block 1 Sec/Sub. LEXINGTON HILLS 1 Parcel No. a Name H& Z PARTNERS w z Address P.O. BOX 2997 o City LACROSSE, WOhone 608/784-5910 ZQIName S? I V V Address P City Phone yVjW Name JERRY SATERBAK ?z Address N751 BLOOMER MILL RD a W City LACROSSE phone 608/788-2764 OFFICE USE ONLY On Site Sewage _ Occupancy R1 MWCC System _ Zoning Pn On Site Well _ Type of Const V 1 HR City Water _ (ACtual) (Allowable) ? # of Stories Length 1 R4 Depih ec ? on n S.F. Totel o Footprint S.F. ' APPROVALS FEES Assessments Permit 1,703.50 water/Sewer Surcharge .00 Police Plan Review 851.75 Fire SAC, City I_.92D.- 00 Engc SAC. MWCC 10,080,00 Planner WaterConn. 10,040.00 Council _ water Meter N A I hereby acknowledge that 1 have read this plication and state Bldg.Off. _ Road Unit 85 .00 thattheinformationiscorrectan agreetoc plywithallap ablel APC _ TreatmentPl ?- 00 State of Minnesota St u a City an Ordinance . Variance _ Parks N/A Copies Signature of Permittee TOrAL $34,197 25 A Building Permit is issued to: H& Z P RTN S on the express condition that all work shall be done in accordance with all aqqlicable 9iate qf Minnesota Statutes and City of Eagan Ordinances Building Official CITY OF EAGAN N2 13330 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHON E: 454-8100 \46 ? 13? b 2005 COMMERCIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 2c0 3 l 3 - Date - / / 3 Site Address 41 ry v e s. Unit # Tenant Name ttylyw6N s Former Tenant Name Property Owner Telephone #( km. )`?'Jo?-'A?3 Contractor Y-k?Z ?Glry,`?Ct j Address ?Af v- Ni City H*M L-}'{'lLE State Zip 3 1)? Telephone # (top) License # Expires: 12AL-65- The Applicant is Owner ,/ Contractor Other Work Type New Bldg _ Modify Tenant Space RPZ PVB _ New Repair ebuil _ Replace _ Irrigarion system Work within pubGc right of-way/easement _ Yes _ No Rain sensors are re uired on irri ation s stems Description of Work QeIU lil I` IG M!/W 2-)41 V?? ?? '741,P `i"Cp To inquire ifPressure Reducing Valve is requir nn new service, ca11651-675-5646 Meters - Ca11 65 1-675-5300 to verify that hydrostatic, conductivity, and bacteria tests passed prior to pickin g uo meter. Irrigation Size & Type Avg GPM 2" turbo req'd unless smaller size allowed by Public Works F1re Size & Price 3/4" diMlacement $161.00 Domestic Size & Type Avg GPM Includes high demand devices? _ Yes _ No Flushometers _ Yes _ No PRV Required _ Yes _ No Permit Fee $50.50 minimum (includes State Surcharge) Contract Value $ x 1% _$ Permit Fee $ Meter(s) Required on all new buildings & boulevard irria?on svstems $ Radio Meter Read If permit fee is $1,000 or less, surcharge is $.50 $ State Surcharge if permit fee is over $1,000, surcharge is $SO per $1,000 of the Permit Fee ---------------------------------???- Following fees apply only when installing new irrigafion system $ - '-------? ? Water Perxnit Call Jerry Wobschall at 651-675-5024 for reqvired fee amounts $ Treatment Plant $ Water Supply & Storage $ State Surcharge ----------------------------------------------------------------------?---?--\------------- $ ?-?/ • ? ---------------------------------------- Total Fee =7717 ?17 1 hereby apply Yor a Commercial Plumbing Pemut and aclmowledge that the information is complete and accuratie;?thafthe?w?orkLwilJb? i.? . conformance with the ordinances and codes of the Ciry of Eagan and with the Plumbing Codes; that I understand this is not a perrmt, but only application for a permit, and work is not to start without a permit; that the work will be in accordance with the appro plathi c@;eW which requires a review and approval of plans. m 1 c'-w cI Lk-!s--" n ,,-J Applicani's Printed Name Applicant's Signamre t' y-_-- ---- PERMIT #: I? + y?? ra ? :.? . . . . a ; CITYUSE ONL'Y f . ; . ?c-- • , ? :;RECEIPT DATE: ColnufficUiL ipL??a PERMIT AiqucALTION 8$SO PQ:Qf S1NOB $D fA6!!R,!!Nli51E8 6!f 1-8$1-467? WORK TYPE New Bldg Add-on . Repair .. RPZ X_ PVB ' Irrigation system. • Must complete reverse side of application also. Required meter size is 2" turbo uc s smaller size permitted by Public Works DESCRIPTION OF WORK 12? To inqnire if Pressure Reducing,Yatve is required.on ne`:service, ca11651fi81-4G46 .. ....... . . .. .. . .: .... .. METERS - Call 651-681-4300 to verify that hydrostatic, wnductivity, and,bacteria tests passed prior to uickine uu meter Irrigation Size & Type Fire' ? Size 8c Type Domestic Size & Type Does this inciude lugh detnand devices7 FLUSHOMETERS Site Address: _ Yes _ Yes _ No e Uf- Avg GPM Avg GPM Avg GPM No PRV REQUIRED _ Yes _ No TenantName:`'/Z°X/r')CJTV ? Was diere a previous tenant in this space? _ Y_ N. If Yes, Name: , Installer Name: "-"/iA6 Telephone #: - o26 90 / (Ama Code) InstallerAddress: ?--9?Qa 1i i,?/(' ? l? A? /v City: Stete: Zip Code FEES Contract prlce $ /v Y- (3 0. a 1% ($50.00 minimnm) ` Contracf Fee $ ??.,_.. _ - _ . ,.a... . .. . .. . . ,., . Meter(s) $ Required on all new buildings & bonlevard irrigation systems (Acct # 9220=4509). ,Ratlio_ Meter Read $ Stircharge: $.50 Minimum. If contract fee exceeds $1,000, calculate at 50 cents per $1,000 contraet fee. Total From Reverse Telephone #: Z7,&1- (Area Caae) State Surcharge $ 1-_<0 New Service $ Total I hereby acimowledge that I have read this application, state that the infoimation is cocrect, aQd agee to comply with all applicable City of Eegan ocdinances. It is the applicant's responsibility to notify the property owner tUat ihe Ciryof Eagan•assuqies no liability for anydamages caused bythe Gtty during its normal operatioml and maintenance activities to the faciliaes constructed imder this pe vAtbm ' ' property/right-of-way/easement ' SIGNATURE OF PERMITTEE CI1'Y USE ONLY REQITIRED INSPECTIONS: _ U.G. _ Air Test _ Gas Test Rough In _ Final P?AN5.SUBMITTED APPROVED BY: , BUILDING INSPECTOR CITY USE ONLY PERMTC #: i? qLq-a RECEIPT DATE: 7) - ? `{ - U PLUM?e PERW AMIGAIION CI'['YOF i:R6*F 3830 PII.QI' KFOB RD RA614P. MN 55188 651-6e1-0175 rNrnMPLETE APPLICATIONS WILL NOT BE PROCESSED Date: o? - C9 $ - c) I WORK TYPE New Bldg Add-on _ Repair x RPZ _ PVB Irrigation system ' Must complete reverse side of application also. Required meter size is 2" turbo unless smaller size pennitted by Public Works DESCRIPTION OF WORK ?1 l? 7. ? e?T F i Yl S't d 11 e-A N eSQ v' 014 e, To inquire if Pressure Reducing Valve is required on new service, ca11651-681-4646 METERS - Call 651-6$14300 to verify that hydrostatic, conductivity, and bacteria tests passed prior to aicidn¢ uo meter Irrigation Size & Type F've Size & Type Domestic Size & Type Does this include high demand devices? FLUSHOMETERS Yes No _ Yes Avg GPM Avg GPM Avg GPM No PRV REQUIRED Site Address: q j q C'? L ex; nqAd n A 4 e• S Yes No Tenant Name: LeX, i n qjo n,A } I'S ? p"f S Telephone #: Cv ? y (Area Code) Was there a previous tenant in this space? _ Y_ N. If Yes, Name: Installer Name^ kC. Telephone #: 9 S a- q o2 c) - a l? q? (Area Code) Insralier aaaress: 3U o a 1-`?, b r- cti,(_ City: SA_ ?p t.L i S p? State: FEES Contract-price S 4o 9D? Od x 1% ($50.00 minimum) Required on all new buildings & boulevard irrigaHon systems Surcharge: $.50 Minunum. If contract fee exceeds $1,000, calculate at 50 cents per $1,000 contract fee. Total From Reverse 1Ylt? Zip Code S?v' y ato Contract Fee $ Meter(s) $ Radio Meter Read $ Stace Surcharge $ •S? New Service $ Total $ ?O Sd I hereby aclmowledge that I have read this applicarioq state that the informarion is correct, and agree to comply with all applicabte City of Eagan ordiuances. It is the applicanYs responsibility to norify the properry owner that the Ciry of Eagan assumes no liabiliry for any damages caused by the City during iu nomial operational and maintenance activities to the faciliries constructed under thi permrt ithin City property/right-of-way/easement. r , .?,7 SIGNP.TURE OF PE " CITY USE ONLY REQUIRED INSPECTIONS: _ U.G. _ Air Test _ Gas Test _ Rough In _ Final PLANS SUBMI71'ED APPROVED BY: , BU[LDING INSPECTOR ???'.k*??????{.7P74i`•k?%??i?k*?it?.?'?'?(?f??3?"a?*'??' ?'.? . ?Ca.?Y OF EA?'i-N ii .. . . . ,. ..P . . ' L;AaH:I:ERs S 7EFiMTMAI_ N1J! R(-1'CEa 0Ef18!99 TZt1E„ i,dL?3xn:i[l , p NAME: T(3F` GllN ING` ii ^ar i. n r9?}0?nL7V?l?. 1 414C7 t_EX. hWt ? 97.0 f7L?.JJ J' ':?'?qD L.G.s\ A?yL • .I? ? ? [?..wL?4 .?:•. . . .. , . I : , ' ' i'. . . .. ? • li ? . . . :. ?: ' . . ._. . . .. . :? .. : ratal r,c;ce,:p?t Amoj.mt: CFi.VS33 ..i.1SEf,• 711n NAN.r,y " . ' i , ?%*kc*%X***Xs?K??K?c**?F???'?k?K?K?KW?*?k?k?k?c?X*??:?K?ka+ik ' ? ,. ? 3 6qa ? 1999 BUILDING PERMIT APPLICATION (COMMERCIAL) CITY OF EAGAN (651) 681-4675 Submit following to obtain necessarv oermit Foundation Onl New Construction Interior Im rovement structural plans (2 sets) civil plans 2 architectural plans (Z sets) architectural plans (2 sets) ( sets) code anal sis Y (7) " structural plans civil plans (2 sets) code analysis (1) •• project specs (1) landscaping plans (2 sets) (2 sets) project specs Key Plan (1 set) Spedal Inspections & Testing Schedule " code analysis (1) " energy calculations (1) not always ° SAC determination letter Trom MC/ES - soils report SAC determination letter irom MC/ES - (1) Electric Power & Lighting Fortn SAC determination letter from MC/ES - (1) not always " pll 602-1000 call 602-1000 p11602-1000 Special Inspections & Testing Schedule (1) " project specs (1) energyplwlations (1) •• Electric Power & Li htin Form 1 •' ' Cnntact Lli ?Min., I..?..e..rc...,? s..... _?_ Food & Beverage or Lodging facilities: Plan must be submitted to Minnesota Oepartment of Health. Call 215-0700 for details. DATE: WORK TYPE: X NEW _ REMODEL DESCRIPTION OF WORK: CONSTRUCTION COST: 36-ODG 0,6 TENANT NAME: SITE ADDRESS: LOT '5?_ BLOt;rc _!1_ SUBD. SUITE #: DL4 U"_ v=?' Tame: ?nq ?,? ? ? 9?? ??(n ?? c, fAIIS k 1 1?1?C-? Phone ?: PROPERTY Last irst OWNER Street Address: 11(o < 1;N1nJ0 -&y / City State: / / ? ?• Zip: Company: I OD A o, ine. Phone #: CONTR4CTOR StreetAddress: ??lti3 ? A?or ? a b- B ll? Cit}, 3iaie : 1 1 I! V Zip: &SC13? ARCHITECTi ENGINEER Company: Phone #: Name: Regisuation #: Street Address: City State: Zip; Sewer 8water Iicensed plumb,e? (only i-i stalling sewer & water): I hereby acknowledge that I have read thi5 application, state that the information is cor t, and agree to comply with all applicable State of Minnesota StatuteS apd?i?Eagan Ordinances. ? ? Signature of Applicant: • i G-`C oc t vvi tf) b\' Hl l L S P.I.D. # :?I, . . ! - . . . . ? ? ? • . 1986 BIIILDING YEHlQT APPLICATIOB - CITY OF EAG9N HOTS: ALi. CONTRACTOES MOST Bfi LICENSED iiITH THE CITY OF EAGAA . 3IAGLE FAIMY DW6LLINGS 3 .. . .. =•`._ INCLODE 2 SETS OF PLANS, 3 CERTIFICATES OF SIIRVEY, t SET OF ENERGY CALCQLATIONS IlDL.TIPLE DWEI.LINGS - RESIDENTIAL BENTAL IINITS ?q- FOH SALE IINITS . INCLUDE 2 SETS OF PLANS, CEETIFICATE OF SIIRYEY - CHECS WITH BLDG. DEPT.9 1 SET OF ENEAGY CALCULATIONS CdMRCIAT" INCLUDE 2 SETS OF ARCHITECTURAL & STROCTURAL PLANSp 1 SET OF SPECIFICATIONS AND 1 SET OF . ENERGY C6I.CULATIONS, E2,000 LANDSCAPE BOND ' • ,. To Be IIsed For: APT: I?A?-. - Valuation: ? , dco Site Address 4(4? LCX. ??C . . Lot 8 ' Block ? Parcel/Sub L?X - t71 LI.S ( Sr ` Joe B Hengel & Donald Zietlow Owner D/B/A H& Z Partners gddress p0 BOX 2997 ':.•{i,.s. w:. i. . , _ City/Zip Code La Crosse Wi 54601 . Phone 608 784 5910 • Contraetor & Z Partners D/B/A .? ?-B Construction Address vn Rf1X 7447 ` -` ' ? •" City/Zip Code La Crosse Wi 54601 Phone oR 7g4 s9in Arch./Engr. __Yrv SatPrhak Address N751 Bloomer Mill Rd Date: . . , Erect ? Remodel _ Repair _ Addition Move Demolish Int.Impr. _ Install APpROVAL.s . Occupancy R•I Zoning P D Type o£ Const TL ( ft?, # of Stories 1L- Length l83 Depth 5,!-,? Sq Ft ZO,? , ?;. . Ra;;4k?:;}?.-•?`.. •, . ?::,.:... . ? City/Zip Code La Crosse Wi 54601 • _ •-;~?`~':". ? ? ? ?.. , ... ,.... ,. . . ; . . ., ` ;. t , f :. , . . .:: : , Phone .? . # FnR ?8? ??64 . , . -. . . ? ,. . . . : , .. < , ....;?;:, w . . . ..... T<r ,T . . . .. _.Y-c . . . . . . . . ' . ' . ' ' . . '. AOTE: ADDEESSES FOR CORNER LOTS - CONTRACTOR/HOMEOHNEE HOST DESIGNATEWHICH ADDRESS . IS DFSIRED, NO CHANGES iiILL BE ALLOTdED ONCE BQILDING PERMIT IS ISSIIED =• ::?1:::? . ? ._l : . . ?.. , . .. . - ' ` - _ . . - .. ! . ? , t ... • . -'? t r?{ Laj h ' " } ? . . ?. - .s . . .. r .." .?.? ? ..«.. i .t^a{^}o++?1b?.?'??^+i . _...,..._..,r. ._. . __r.. ... . ,? . ?... . ..,. .,h . . . ,..?. .:.. ..;i - ., ..:_ , e . . . e : :a. s s ;, : i :: ` :: "? :ii: ? ? . . . _ ., , . .w ....... .. . .. ,.. . q ,., r .. ... . : 4 ?.a ...,.y _. . LEx . (?-- I I g! ? t=X Hc Lc_5 ? 5r CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION ****#*********#**!**?************# . ? *TOTE: PAYMFM OF FM AT TIME OF r,PPiscATIoN ooES NOr coNMTM * APPxovAr. oF PEF44IT. * * INSPDCTION OF SEFE2 ANID/OR MM TIV..STA Ta'i'TONS WII.L NOT BE 9CHED- * * i7IID UMII, PERMLT HAS BFM * APPROVED. * * ? * r . _ . . ? xx,.yrxx?es?e?enx?exx+?nx+e?e+e?e::xac:?r:?r?ryr,rx . P ease Print ' 1) PROPERTY ADDRESS : 0 L ? x I N LEGAL DESCRIPTION: rm,M: ADDREss:-? IF EXIS'PINC; STRtY,'ILiRE, DATE OF ORIGINAL &0ILDING PERMIT ISSUANCE: PRESENT ZONING/PROPOSID LSE: (Nbn ear Q %M-MMERCIALfRETAIL/OF'FICE ? Q IPIDL?STRIAL ? [I INSTIZLrTIONAL/GOVM0E= ? . ? 2) CITY, STATE. ZIP: R-1 SINGLE FAMILY R-2 DLPLEX (Ttao Lnits) R-3 TOWNHOL?SE (Three + Units) ( Units) R-4 APARTMaIT/COmIDOMINIUM (_ay Units ) PHONE: L p!S? ?f ' I ._ , Lot Block Subdivision or Tax Parcel ID ) , . 3) • i: ?• NAME: ADDRFSS: CITY. STATE, ZIP: L ? PHONE:LD-g_:J<2?C-qI mMASTER LICENSE# 00'?-) L gr A 4) •• • ?? •..????+-? "? N11NIE: ?? ( P A b-i' 1 a? ?> r _ ADDRFSS: pI"7 11 77 L O\G ri ' CITY, STATE, ZIP: ? 9 4- "'; z D 1i ? 2 " . PliIInbers License: ? Active Expired Not recorded St Irlitial PHONE: ?n Q q tl '5? , '' ?' ' ?• : a a ?. . ? CONNEC.'TION Tn CITY SEFF]E[2 ([-b CONMX.'PION TO CITY WATER ri OTEER ' . 6) '? • ? ? PLEASE HOLD APPROVID PERMIT FY)R PICK-UP BY ONE OF ABOVE ? Q PLF.ASE MAIE APPROVEd PEItMIT TO 1, 2, 3, @ p,BOVg 7' (Circle one) ? ? ,r • y -FOR -CITY USE ONLY PERMIT # ISSUED Pd w/Bldg. Permit FEES: $ $ / 0 ' $ $ $ $ $ $ $ - $., $ c gv . ?z $ Gr,4 $ $ $ $ $ $ $ $ $ $ $ ? Y ?l I ? ? F> • 61- RECEIPT RECEIPT ? r? • ? L SEWER PERMIT (INCLLDE SURCHARGE) WATER PERMIT (INCLUDE SURCHARGE) WATER METER/COPPERHORN/OUTSIDE READER WATER TAP (INCLUDE CORPORATION STOP) SEWER TAP ACCOUNT DEPOSIT - SEWER ACCOUNT DEPOSIT - WATER WAC SAC TRLNIi WATER ASSESSMENT TRUNK SEWER ASSESSMENT LATERAL BENEFIT/TRLIVK SEWER LATERAL BENLFIT/TRUNK WATER WATER TREATMENT PLANT SLRCHARGE OTHER: TOTAL DOES UTILITY CONNECTIOLV REQLIRE EXCAVATION IN PUBLIC RIGHT OF WAY? ? YES IF YES, THEN A"PERMIT FOR WORK WITHIN P[JBLIC Q ROADWAY" MLST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: I APPROVED BY: TITLE: DATE: DAKOTA COUNTY NAME / DESCRIPTION AND DELINQUENT TAX RECORD PARCELiDENTIFICATION DISTRICT: _A%;AN C I TY School W PROPERTr OESCRIPTIOP DIST PLAT LOT BLK O'strict S SEC lOT .;; 45v,5 v;;;) DIViSiC•N rh`.1681-4 :yE G L`cx1N-GTC;J I1ILLS i5 TRANSfER DATE CFV. NO, LAST GRANTEE Ji 2 5 ?, 1 „iVI5Ik:N 0IY L'cX.lhuTGlJ S?,U'ii i+?l. U: 31 o7 1 ,iJ:4 L=XING71L.N 56U7H Iivr ;;J il Z Z PiNkS 4 17 87 .' r H R 2 vfl,.r...,..., r.m I v ^?? A,Ts a J - 4- Sly .? ; HAUGE, EIDE & KELLER, P.A. ? Atlorneys al aL,aw TOWN CENTRE PROFESSIONAL BLDG., SUITE 200 ? 1260 YANKEE DOODLE ROAD EAGAN, h1INNESOTA 55123 (612) 456-9000 June 17, 1987 TO: Tom Hedges Tom Colbert X Gene VanOverbeke Dale Runkle FROM: Paul Hauge Kevin Eide X Dave Keller Lori Bellin Debra Schmidt 7771 -?7, _,. PAUL N. MAUGE KEVIN W. EIDE DAVIO G. KELLER LORI M. BELLIN DEBRA E. SCHMIDT RE: Lot's 1,4,7,8 and 11,:Block 1, Lexington Hills First Addition ; Project No. 478 Enclosed please find: Development Contract PUD Agreement 1 Easement Trail EasementF Deed Other Action requested: file. Lexington South, Inc. to the City of Eaqan Please place this recorded document in your permanent cc: Bruce Allen ! . ? • ? TRAIL EASEMENT £r A}" r• THIS INDENTURE made and entered into this /,S"-IA- day of , l '4-1 "y' 1,el? , 1986, by and between LE%INGTON SOUTH, INC., as Grantor, and the CITY OF EAGAN, Dakota County, Minnesota, as Grantee. • WITNESSETH WHEREAS, said Grantor is the owner of the tracts of land in the City of Eagan, Dakota County, Minnesota, legally described as followe: Lots 1, 4, 7, 8 and 11, Block 1, Lexington Hills First Addition. NOW THEREFORE, the said Grantor in consideration of One ($1.00) Dollar and other good and valuable consideration to it paid by Grantee, receipt whereof is hereby acknowledged, hereby conveys, warrants and dedicates to said Grantee, its heirs and assigns, for trail purposes, together with the unrestricted right to improve the same, free and clear of all encumbrances, the following described tracts of land: A 10.00 foot wide perpetual easement and across that part of Lots 1, 4, First Addition, according to the Minnesota, the Westerly line of sa southwesterly lines of said lots and right-of-way of County Road No. 43. for street and trailway purposes over 7, 8 and 11, Block 1, Lexington Aills recorded plat thereof, Dakota County, id easement being the westerly or being parallel with and adjoining the The Grantor, for itself, its hplrs, executors, administrators and assigns, does covenant never to cut, damage, destroy or remove any tree or shrub or _ other natural growth upon the hereinbefore described premises for the continuance of this easement, and does hereby grant and convey to the said City of Eagan all grasses, shrubs, trees and natural growth now existing on said lands or that may be hereafter planted or grown thereon. The Grantor, for itself, its heirs, executors, administrators and assigns does hereby release the said City of Eagan, its successors and assigns, from all claims for any and all damages resulting to the lands through and across which the parcel of land hereby conveyed is located by reason of the location, grading, construction, maintenance, and use of a public trail over and upon the premises hereby conveyed and from the uses incident thereto, and the said City of Eagan shall have the right to use and remove all earth and other materials lying within the parcel of land hereby conveyed and the right to construct and maintain, upon the lands adjoining the parcel hereby conveyed, such portable snow fences during such montha as weather conditions make necessary. All stumps and other debris resulting from the clearing of the right-of- way will be disposed of by Grantee by burning or otherwise, according to law. The Grantee shall have the right to post such signs and posters along said trail as are deemed necessary and suitable to define the above lands and locate them for public use. • • 1 ' I . LEX/NGTON HILLS FIRST ADD/TlON i z ? - -- ? I\ \S \ ?M?rl? li? 1I fN SI 1/1 1/ /1? Sf 1/1 ?/ S.cl?n L7 ? , -I . . ?v . S89'49'!9'E 123926 "" '? ? yo ? _Tin__' __' a?.? _ •.' ..sis?.1• ? ' w.w t __ - ? ?? + wm ??m. ?Kb lp Z \ty ? ?i s kt :`. ; 1 I ?• •,` * ' ` . •? • f ? 1? \ r.`??t'?+, ?J h. . I N I A ?? • ` N \ ? ? . ?` i? 4 ?.. y9 ?i ?:'^q, ??i.+ ?? i e ?ti'i??'?, ° I' 4 ?@ `? i? •?\ ? :?? . ? ? ?" - ? _ p • '{x'? .I :' \ ` 9? • ?i' / T '. .y . ``, W - ? - I ?. o ?d` ?'?t,.'*•? s T,- ' i s? ? `? ?` • e „o•''?j`; ?? ? i i xbr??A ?I ? ? i? " ..?. •'? "°`r°°` e ' "1.-..J? - +?? +?+? i us 080dOd ?¢?1 ? • I KNl IF . \\? ?' .R??K .... . ? ..,... ...... _ ? ? ? Street and Trailway Eaeement EXHZBIT `.X'Z, N8948'OeW ? 1p , ( •? i' 2 ? A 10.00 foot wide Perpetual Easemeat- Par Street and Trailway purposes over and acrosa thai part of Lots 1,9,7,8 and 11, Slock 1, LE%INGTON HILLS FIRST AODITION, according to tha recorded p1aG thereof, Dakota County, Minnesota, the Westerly line of said easement being the Weeterly or Southwesterly lines of said Lota and being parallel with and adjoining ' - the right-of-way of County Road No. 43. r 9 ,? . ? - . ?- • r IN WITNESS WHEREOE, said Grantor has hereunto set its hand atPtDc?stak the day and year first above written. ; LEXINGTON SOUTH, INC. BY: i zts: sy: Its: STATE OF MINNESOTA) ) ss. COUNTY OF Q & ,?- ) On this 15?4 day of ?pc2?r?,c/Z , 19L?, _before me a Notary Public within and for said County personally appeared _/p ,?j .4• and ?- to me personally nown, who, being each y me duly sworn that they are respectively the ?jand -- of the Corporation named in the foregoing instrument, and that the seal affixed to said instrument is the corporate seal of said corporation, and that said instrument was signed and sealed in behalf of said corporation by authority of its Board of Directors and said and -' acknowledged said instrument to be the free act and deed of the corporation. (S EAL) THIS DOCUMENT DRAFTED BY: Hauge; Eide & Keller, P.A. 1200 Yankee Doodle Road Water View Office Tower, Suite 303 Eagan, MN 55123 (612) 456-9000 jJi3 . ;?, JYKS i , PiOTAHY FUSLti;- MINNESOTA \? ,I DAKOTA COUVTY `*? My Cpmmission Expires Sapt.8,1N0 EXEMPT FROM STATE DEED TAR STAMPS Exem dho- pt from Dakota County Deed Tax ?r, Dakote County Treesurer COUNTY CONSERVATIOI? T- lau pDAKOTA TRFASI:RE'l Ak 2004 COMMERCIAL PLIJNIBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 ???-Z?o Date 3 / / (p / ? Site Address Unit # Tenant Name Former Tenant Name Property Owner nGe.,? Telephone # ( ) Contractor c ?F c?1? ?P ? bc? Address _.,3t,Cjn &--Y1ntbp[• ?-- ?C3a- City State m N Zip 6"C5 ("a' Telephone #(?jn The Applicant is _ Owner Contractor _ Other Work Type _ New Bldg _ Add-on Repair RPZ PVB Irrigation system * * Jer WObschall to calculate fees. Re uired meter size is 2" turlw unless smaller size ermitted bv Public Workc Description of Work t'1Q.tY?(1?-2_ ot (!Cqp 1?w(' ?? bL\g? To mquire if Pressure Reducing Valv is required on ndw service, call 651-675-5646 Meters - Call 651-675-5300 to verify that hydrostatic, conductiviry, and bacteria tests passed pe3or to oickine uu meter Irrigafion Size & Type Avg GPM Fire Size & Price 3/4" displacement $155.00 Domestic Size & Type Avg GPM Includes high demand devices? _ Yes _ No Flushometers _ Yes _ No PRV Required _ Yes _ No Permit Fee $50.50 minimum (includes State Surcharge) Contract Value $ x 1% _$ Base Fee $ Meter(s) Required on all new buildings & boulevazd irrigation svstems $ Radio Meter Read If base fee is $1,000 or less, surcharge is $.50 $ State SurChaTge If base fee is over $1,000, surcharge is $.50 per $1,000 of the Base Fee ' ----------°------------ Following fees apply only when installing new irngation system _$____.- __ ------------------------ Water Permit Contact Jerry Wobschall at 651 fi75-5024 for required fee amounts Treatment Plant Water Supply & Storage f I State Surchazge --------------------------------- - - - ---------------------------------------------------- --- -- --- ----------------------------------- $ Total Fee Mj?vy apply tul a k-ommerciai riumomg remut and acKnowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that I understand this is not a permit, but only an applicaeon for a permit, and work is not to start without a pertnit; that the work will be in accordance with the approved plan in the case of work which req review and approval of plans. 12ti_Seh,e? ApplicanPs Printed Name Applicant's Signature ? ?- --------------? ? For Offce;Use ? yr? Q?j j Permit #: O? Q" ? I j Permit Fee: ?? I 1'?? I I I ? Daie Received: ? Staff: 2008 COMMERCIAL BUILDING PERMIT APPLICATION Date: ? Z O?f Site Ad? i s: oZEK(N67U, /-rc.,Z S Tenant Name: f EKI?v6-(0&j dlcLS (Tenant is: New! k- Existing) Suite#: PROPERTY OWNER Name: AAC'u2 , 1ti ` Phone: -! ?"?Z "595 - 0`197 - Address / City / Zip: 6qa 1 /7T Wt JTIYC(.J! 0 2- Applicant is: _ Owner ?C Contractor TYPE OF WORK Description of work: I G "- IL Y2C'D)- Ge cS I C ll Vl C, Construction Cost: C, , `??? • ? ?}' 10 5co 4 J (P, ?(?(? •"? CONTRACTOR Name: G?AtIC.CYL License#: yZ2-q Address: ZZ7v C/7tv City: &`s /''A?tr State: A/"&-? Zip: ssl/Y Pnone: &S( -ZSl -0 910 Contact Person: 6-/1- 1C te 12-70 3- (0 3?f ?' ARCHITECT / Name: Registration #: ENGINEER Address: City: State: Zip: Phone: Contact Person: Licensed plumber installing new sewedwater service: Phone #: NOTE: Plans and supporting documenis that you submit are considered to be public information. Portions of the information may he classified as non-public if you provide specific reasons that would permit the City to conclude fhat fhe are trade secrets. I hereby acknowledge that this information is complete and accurate; Ihat the work will be in conformance with the ordinances and codes of the City of Eagan; thal I understand this is not a permit, but only an application for a pertnit, and work is not to start without ermit; that the work will be in accordance with ihe approved plan in the case ot work which requires a review and approval of plans. ?J x ,grc..E- Applicant's Printed Name Page 1 of 3 Use BLUE or BLACK Ink r For ,Ilk Office Use I Permit City of Ea Rd Permit Fee. I 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: I Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I I 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: E , Agn;f _~o- Unit Name: z Phone: '76 a-- 3)14 Resident/ / Owner Address / City / Zip: A- Applicant is: Owner V Contractor Type of Work Description of work: Pe Si 4e- Construction Cost: J? 5 , `^S Multi-Family Building: (Yes JL / No Company: w ✓erwr-S -77) C', Contact: "'ktze 4 Contractor Address: 134e .S✓-,~ A'A4 City: IV/ State: 4111.1 Zip: 2 ~7 Phone: d s GBH 6 3 4e License 1~e_ 5_X 32 7 41 Lead Certificate /VA-r 79,' 53 0 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 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 to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. 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 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 issuance. X_ I.AZf aam, L-er x Z_-, /e Applicant's Printed Name Applicant's Signature Page 1 of 3 Use BLUE or BLACK Ink r________________.- I For Office Use � Clt of Ea a� ; Permit#: ��°� � Y � � �_ � 3830 Pilot Knob Road � Permit Fee: I Eagan MN 55122 I I Phone: (651) 675-5675 � Date Received: � Fax: (651) 675-5694 � I � Staff: I �-----------------I ��'. 2014 MECHANICAL PERMIT APPLICATION ❑ Please submit two (2) sets of plans with all commercial applications. II Date: �( � i�{ s�te aadress:_�/�I yD 1.F X�K1 G `f� � �(1� �'l�G�9 t1-� 'I Tenant: Suite#: � �c� /'�/f ti�c� s m��„� � Fhon��?63-1-(��'– 3//f.��,_ Resident/Owner Name: �� Address/City/Zip: �{� �� W�sT r r�c,v1� G'fw �s?Af�� 3�� Name: � � � Lc1 ihyS (1��"�S License#:_��'1 C�S� �a� Contractor aadress:_1�S � 6�L(1 f,� t,(� 1.�- c�ty: ClP2C'�, � ��iv�S (� U m��n State:�Zip: .5,�d�� Phone: �/,�' ��^ �� ^ (�(�U6 Contact: C�SI' al� - ��'/ Email: New �Replacement Additional Alteration Demolition Type of Work Description of work: NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code.,Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL COMMERC/AL _Fumace New Construction _Interior Improvement Air Conditioner Install Pi in Processed � Permit Type — P� s _ I _Air Exchanger �Gas P(Pf�G _Exterior HVAC Unit _Heat Pump _Under/Above ground Tank �Install/_Remove) � _Other �� RESIDENT/AL FEES � $60.00 Minimum Add or alteration to an existing unit(includes$5.00 State Surcharge) �`� $100.00 Residential New(includes$5.00 State Surcharge) _$�Q�� TOTAL FEE COMMERCIAL FEES Contract Value $ x.01 � $55.00 Permit Fee Minimum � $70.00 Underground tank installation/removal =$ Permit Fee � 'If contract value is LESS than $10,010, Surcharge= $5.00 =$ Surcharge` � ""`If contract value is GREATER than $10,010, Surcharge=Contract Value x$0.0005 � *"If the project valuation is over$1 million, please call for Surcharge =� TOTAL FEE � _ 1 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 wi�l be in accordance with the approved plan in the case of work which requires a review and approval of plans. x t? ,rv ?� X Applican 's rinted Name ApplicanY S'gnature FOR OFFICE USE __ Required Inspections: Reviewed By; � 1 Date:� � � � -- Underground Rough In Air Test �s Service Test In-floor-Heat � --�ir�al HVAC Screening Use BLUE ar BLACK ink �-----------------� � For Office Use � ` � Permit#:i' ��6`�_ � �� I . �-�l.,e � � Permit Fee. � � 3830 Pilot Knob Raad � � Eagan MN 55122 � Date Received: � Phone:{651)67b-a675 ��;�� .°' �' '. .� � sta�: � Fax: (651j 675-5694 �----------------, 2015 RESIDENTIAL PL.UMBING PERMIT APPLICATtON D�te: �' ( � Site Address: ��``1� � 1 l�'.�-`� Tenant: s rn !:7 Suite#: , . °��1��t��` ; Name: �� `�� Phane: _��t '��1....)�� M�� ; Address/City/2ip: l� �� ..`� � � �°'� . ' `�� Name: � , �� icense#: �+E�1`1�t�C#�t'. " Address: �.,' � . Gity. � .�I�-r��14�' 5#ate: Zip: Phone• �---., ` � �..t�`- Contaac.t: � ' Emait: �� New Repiacement _Repair �Rebuiid Madiiy Space Work in R.O.W. "��ti�� - — — ._ Descriptian of work: ' tC" RESIDENTIAL Water Heater Water Softener �awn Irrigation(r RPZ/_PVB) � �� Add Piumbin Fixiures Septic System 9 (_._�ain/__,_Lower Level) New Water 7umaround Abandanmerrt REStDENTIAL FEES: �60.Q0 Water Heater,Water Saftener, or Water Heater and Softener(includes$5.0o State Surcharge) $60A0 Lawn irrig�tion(includes$5.OU minimurn State Surcharge) $60.00 Add Plumbing Fixtures, Septic Svstem Abandonment,Water Tumaround'`(includes$5.00 State Surcharge) *Water Turnaraund{add$200.00 if a 5/8"meter is required) $115.00 Septic SYS#em New($10.00 per as bui}t)(includes County fee and$5.00 Sta#e Surcharge) ' TOTAL FEES� CALL BEFOFtE YOU DIG, Caq Gophes Siate One Call at(B�1)454-0002 for pro#ection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org I hereby acknou�edge that this information is complete and accurate;th�t the work wiil be in canftarmance with the ordinances and codes af the City af Eagarr, that i understand this is not a permit, but only an apptication for a permit, and work is not to start with ut a permit; tFrat ttre work wi8 be in accordance with the approved p�n in the case of worlc wfiich requires a review and appro of plans. X S d �. X Appi cant's Prini Name Appli ant s Signature #�fl�t�F"�� 1��r��t�!�'!y;: .: �i��,` �,�q��r+�l�p�f��* ` �r�der�� #�-��; �r��t :.,�,...;,��T��t ��nai, M��d i�s: : 14�'�r��,:,,�, ��e�c�.�..;..; �t�rria�ri��r�;,� ��`: