1769 Hickory HillYILLAOE OF EAGAN WATER SERVICE PERMIT
3795 Pilot.Cnob Rood PERMIT NO.: 176 _
Eoqon,MN 55714 DATE: 6/59/75
Zoning: PUD No. of Units: .
Owner: NPw Hnrizo n HnmaG - Woodaate Sj _
-?
Address: rt?
Sire Address: 1769 Hicko ry Hill
Plumber: Thompson P lumbing Co.
M ter No.:-?Z? Connection Chazge:140-D0 pS7_.
Sa-=' 2 Account Deposit:
Reader No.: 7-S??r,l ? i Permit Fee: 10.00 il Pa
I o to am wiih.fhe Village of Eayan Surcharge: .50
Ora'a?esl l° Misc. ChargPC: '? d, •e'---6
Tocal: -1L'0% 4
By Date Paid: .
Dace of Insp
: Insp.:
.
YILLAOE OF EAUAN SEWER SERVICE PERMIT
3795i%r9.' 44 Rood PERMITNO.: 2525
Eagan, MN 55122 DATE: 6/19/75
Zoning: PUD No. of Un1ts:
Owner: Npw Ho izon Homes - WooQqate II
Addreee:
Site Addrese: t 7a4 ui rkO.-v ra; 71
Plum6er: mhmcnpson Plurtbinq Co
I aprw ro eomply wIM the Vlllaqe ef fwpan Connectfon Charge: 425.00 pd
Ordinanew. Account DepoeSt:
ia
p
Permit Fee: 10. 00 oi
Surcharge: ' 50 jod
By: Miec. Chargee:
Date of Inap.: Total:
Insp
: Date Paid:
.
ities DiRital Oualitv Control
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CITY of EAGAN
BUILDING PERMIT
.._, ..
Ownu ......... ...... . ...... ...... ...............
`/) , , . . ?' -F -. --C
.- /, 1k
... ........ ....... ...... ................ . .............. ........... ....
Addreec (preaen!) • • ? ? ? ? ?' '
Suilder ...................................... ....................... ............................ ...
Addeesa .....
DESCAIPTION
N4 3603
3795 Piloi Kno6 Road
Eagan, Minneso2a 55122
454-8100
Dale .... ......-. ------ •?---
Siories? To Be Used Fas Fronf Depih Haigh! Eal. Coo! Pe:mi! Fsa Remssks
LOCATION .? 7. i " , S-e
52reex, noaa or o[ner uesanpvon oi ?ocaxion Lo: oiocr waaiaon or -rraet
i ?
Qa.c ?..?.Z..Y.t:
/: This permit does nof auihorize the use of sizeels, roads, alleys or sidewalka nor does i2 giva the ownet oe hit aysnt
the righito creafe enp situafion which is e nuisance or which presenis e hazard !o the healih, safely, eonvsnienes and
general welfare !o anpone in the eommunify.
TH1S PERMIT MUST BE KEPT ON TFIE PREMISE WHILE THE WORK IS IN PROGRESS. .
y !hel ....? . . . ............haspermission !o erect a... 1_71:l....." --?<_..._ L_ ?..
This is !o eeriif
l- :..!:_.??1`.:...... .. ...........¢ ..:.'-....."' .............. _upoe
fhe'above described premise su6jecY !o thc:p ovisions of all applieable Ordieances for the Cify of Eagan
- '
.
I c•--te ?e?_ liL?. ?- .? ? t"?---
.
° .......... ..._..._...........
.:.°---..._.........--'it "°--.......°-........ Per ....... ...... .--............-................ ......:......}.....
Mayor ?J Suildinq ?tpaeloi
?
?
? CIT]t OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
PERNLTT NO.: 736 _
The City of Eagan here + grant??Q?'_? oM
frP +,?'?'
?'., si?ve. ¢o:'.
M : . '
Permit fori ':(Claner) " mv E
?.?, , . . -
at ],771. ,1767. 1(69 ?iLterv 7mrour8Llemt t0 8pp13QeJ
- ??+
Fee Paid: 560.00 dated this 30_ day of _jjgpt_ ;"T915_
1.50 s/c
Building Inapector
N?chs?iiczl Permits:
bic: 'i' ,i;nl:
a'
. _? . ,
/ ? - l/ io
CITY OF E.4G.+N
3795 Pilot Knob Road
Eagan, Minnesota 55122
PERiY'"iIT NO,: 571
The City of Eagan hereby grants to m1,a=son pt nnut ?ng oo.
ef 72201 Minnetonk++ B1Vd
a orsnmrxr. Permit for: (Owner) NeN gprizon Homes - Woodaate
1775 76?74,72,70,68,66,64,62,60,58,56, and 54 9Palnut Iane 8nd 1757,59,61,65,67,
at ?Z71, ,,,,A sA plrknrv uinursuant to application dated 6/16/75
Fee Paid: $d7n_nn dated this lgth day of Juna , 19 75
10.50 s/c
Building Inspec
Mechanical Permits:
Bid Total:
Wo A nd ,b
"' L Ig. R G
Ciinr OF EIAG <iN
Pi7.1Y Knob FOSd
Eag:,n, P%iinnoso'la 551•22
FEFu 7IT P?0 , :
Tlie Cit,y of Eagan hereby gr:nts to _??ers Soft Water Co.
o£
Water Softener permit for: (Owner)
T. Knifel
a- 1769 Hickory Hill ? pursuant to applieWtion daied 5/24/76____
Fee py_.d; $5.00 dated this
. SO 5/c
27 aay of -MaY_ip i976_=
P.uilc,irig In::peo t o4° ----
r.leaharic:l Permi.ts:
I
Hid iot al:
CITY OF EAGAN Remarks
Addition Woo?gate 2nd Lat 18 a,k
Owner ? ?` , •' •l , ' ? -- Street 1769 Hickory xill
Improvement Date -Amount Annual Years Payment Receipt Date
STREET SURF. 3 1974 8.52 1.70 Pi
STREET RESTOR. 1976 ? 0-34.7 344.92 Pg7d
GRADING
SAN SEW TRUNK
Y 197 11 .72 7. ? 1 P31d
-MEWER LATERAL
I 197 3 .71 1022. Paid
WATERMAIN
ifWATER LATERAL 197 3
itWATER AREA 197
itSTORM SEW TRK 197 3
itSTOFM SEW LAT 1976
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 140•p0 316 6-3-75
BUILDING PER. 3 3 316 6-75
sAC 2 .00 31 6-3-75
PARK 120.001 16 6-75
CITY USE ONLY
PERMIT #: (? RECEIPT DATE:
$002 RESMENTIA1.. MEL'RALMCiAL ?? ?PLICiATIOR
CPfYOF KA6lkA
S$SO fII.OT KAOB SD
EA6iqR 3I1Y'3.51 EY
651-6$1^4675
Please complete for. ? single family dweilings
townhames and condos when permits are required for each urtit
Date: Cl- ai ` 00-1
SITE ADDRESS:
--44 ,
OWNERNAME: 4'?c??6 C-?L ?C??YISGV? TELEPHONE#: (o 1 -_L?-?T`30I-7
INSTALLER NAME:
STREET ADDRESS:
cITY:
Burnsville Heating & AlC, Inc. TELEPHONE #:
e s an ve. .
Savage, MN 55378-1122 "
STATE:
Z{P:
Place a check mark next to the permit work type
? Add-on, modification or alteration to existin dweliing unft $ 30.00
• fumace replacement
• air exchanger
. airconditioner . SEP 3 0 2002
• other
Nature of work: 0'? F:7-L.A-?VV1G(
State Surchar e $ .50
-?0
'"
Totai -
K)annc pF?
SIGNATURE O PE EE
1102
CITY USE ONLY
PERMIT #:
APPROVED BY:
INSPECTOR
RECEIPT DATE:
8008 COEMWRCL&i. MMCHANICAi. PEMIT i4PPLICATION
CiTY Og £A6AN
ssso Pu.o•r xxo$ itn
KlGkN, lilN 55192
_ 651-8$1-4675
Please complete for alf commerciatrindustrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
STTE ADDRESS:
OWNER NAME:
TENANT NAME (IMPROVEMENTS ONLI):
PHONE #:
WAS THERE A PRE VIOUS TENr11V1' IN THIS SPACE? _ Y_ N. NAME:
INSTALLER
STREET ADDRESS:
CTI'Y:
TELEPHONE #:
WORK TYPE:
Specify Nahue of Work:
STATE: ZIP;
- New cos+suctian
_ Interinr Improvement
_ Pmcessed Piping
? Install U.G. Tank
_ Remove U.G. Tank
N'hen installing/removtng underground tank, call 651-681-4675 for inspection by Fire Marshal and
Plumbing inspector.
Fces: I% of contract price OR $50.00 minlmum fee, whichever is greater.
Underground tanlc removaUinstallation = minimum fee
Contractprice: $ xl%=$
State surcharge
TOTAL
$
(Base Fee)
calculate at $.50 for each $1,000 Base Fee
SIGNATURE OF PERMITTEE
Updated 1102
PERMIT # "i ? ? ? n
,Afo,?-1>(P
Please complete for
SITE ADDRESS:
OWNER NAME: :
INSTALLER NAME:
STREET ADDRESS:
CITY:
RECEIPT DATE: L' ? h?-V '
U5IDEN17AL fLUMSINfi PV MIT AfPLICATiON
?"OFEA&AN
SSSO PILOT I{AOB i{D
fs4&AP, b1N 55122
651-6$1-4675
? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for irrigation system
I? 1
WSJ
1.1i Lx?
Place a check mark next to the ermit work t e
TELEPHONE #: &% I ?)-7
(AREA CODE)
TELEPHONE #: 9SZ_ 93J -967i?
(AREA CODE)
STATE:
ZIP:
-
New residential dwelling unit under construction and not owner/occupied ?
$ 90.00 '
Add-on, modification or alteration to existin dwelling unit, including: $ 50.00
• abandonment of septic system
• new installation/repair/rebuild of RPZ
? • lawn irrigation system
• waterturnaround
vowt I
N
t
`
)F'?r-?
-
a
urec
work:
-
Septic System, new/refurbished - $ 225.00
• includes County & Consulting tnspector fees _
• requires MPC license
?'la. ,?UN 22
State Surrharge .50
- ---
?`' _ ?• Jv
_
Total $
Reminder. Be sure to scheduie inspections af alterations, i.e. water heaters, water safteners, etc.
1 hereby acknowledge tnat I have read this applicalion, state that [he informahon is correct, and agree to compry with all applicable Cityof Eagan ordinances. It
is the applicant's responsihility to notdy the property owner ihat the City of Eagan assumes no liability for aryMdamages caused by the City during its normal
operetional and maintenance activdies to the facihhes constructed under this permil within City NpertylnyyJ-of-way/easemen[.
Updated 1101
/ao95/
, r/ gL I^ CITY USE ONLY
L RECEIPT 77C9>?`?"
? iy
SUBO. RECEIPTDATE: ? -7/ilv'
1997 MECHANICAL PERMIT (RE5IDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? single family dwellings
. townhomes and condos when permits are required for each unit
New construction
Add-on furnace
V Ad 04-on a'v condit;oning Add-on air exchanger, i.e. Vanee sys±em, etc.
Date: /'99z
FEES
? Minimum Fee: Add-on/Remodel (existing residence only) $ 20.OD
? HVAC: 0-100 M BTU 24.00
Additional 50 M BTU 6.00
? Gas Outlets (minimum of 1 required @$3.00 each)
? State Surcharge .50
TOTAL °ZQ.3 n
SITE ADDRESS:
OWNER NAME:
INSTALLER NAN
STREET ADDRE
cirv:
t
PHONE#:
PHONE#:
ziP: .5.,gqR
CITY USf- ONLY
L BL
SUBD.
RECEIPT#:
RECEIPT DATE:
1997 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for.
DATE:
CONTRArT PRICE:
WORK TYPE: NEW CONSTRUCTION
DESCRIPTION OF WORK:
INTERIOR IMPROVEMENT
FEES: . $25.00 minimum fee or 1°/a of contract price, whichever is greater.
. Processed piping - $25.00
? State surcharge of $.50 per $1,000 of eo rmit fee due on all permits.
CONTRACT PRICE x 1 °/u
PROCESSED PIPING
STATE SURCHARGE
TOTAL
SITE ADDRESS:
OWNER NAME: TELEPHONE#:
TENANT NAME: (IMPROVennerrrs oNLv)
INSTALLER:
ADDRESS: _
CITY:
PHONE
SIGNATURE:
STATE:
SIGNATURE OF PERMITTEE CITY INSPEGTOR
? all commerciaVindustnal buildings.
? multi-family buildings when separate permits are not required for each dwelling
unit.
ZIP:
g> ? .,
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 1769 Hickory Hill
Lot: 18 Block: 6 Addition: Woodgate 2nd
PID:10- 84601 - 180 -06
Use:
Description:
Sub Type: e- Reroof
Work Type: Replace
Description: House & Garage
Census Code: 434 -
Zoning:
Square Feet: 0
Comments: If there is no ice protection inspec
acceptable in lieu of inspections.
Fee Summary:
Valuation: 3,000.00
Contractor:
Lindus Construction
879 Hwy 63
Baldwin WI 54002
(715) 684 -4647
PERMIT
City of Eaan
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Total:
Applicant/Permitee: Signature
- Applicant -
Construction Type:
Occupancy:
on prior to final, you must meet inspector with ladder and flat bar. Pictures are not
Owner:
James R Palmehn
1769 Hickory Hill
Eagan MN 55122 -2412
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$88.50 0801.4085
$1.50 9001.2195
$90.00
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Building
EA085286
08/14/2008
ePermit
Use BLUE or BLACK Ink
r------------s__-� .
I For Office Use �ti/�j��
i / 5.�/��r��
� � Permit#:/ � L � '
Clty of �a��� I Permit Fee: �/�� 'I /�
�
3830 Pilot Knob Road r- I I
Eagan MN 55122 RECEIVED �� C� ' � � Date Received: ' �
Phone: (651)675-5675 � I
Fax: (651)675-5694 S�P 1 � 2��� StP � � �}��i5 i Staff:, i
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ���3` ��S SiteAddresst 'llo� �c.kc� • Unit#:
��Si��� :
Name: �,:.�,. ✓3�r�5�ort� Phone:_ l�la-3a?'y��
Q�y#�Q� Address/City/Zip: I�ia�l �7 )G�ry �r�l5 �r�tJt 4
~: Applicant is: Owner Contractor ` ��
Descri tion of work: _ � ✓1�-��" <-- r -�-��"�-�" ��JW�..�f
��7'y�p�of 11�W"k p (�✓4�v►��C T fi� h-f-t'�v� _ ..
Ge►
Construction Cost: _����� ,-- Multi-Family Building: (Yes /No�
� �
Company:-��v.r..t.�. /�S�.-���c�n Contact:� 5�.,�1.�.�,
��t����' .
Address: �f� �, �c�,vu� �Tt-c�c..�" City: �2 /�e. f'�ct�--ux
' State:�Zip: .5 t31� Phone: �07' ��'�°�' Email: �Pay• S t�. S�'-t't/lCe��y�Tiovi ,Co
' License#: �L�y Lead Certificate#: '�'^� d✓��"t ' « � ��y�
If the project is exempt from lead certification, please explain why: �'��� ��-�- �- 1��6��`1�3 "�
C. � �� �� ��9
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 ptan?
Yes No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
I N�T�':P!�»s and�upp��g c�lv+�rr�er�ts�ha�f;�r��r sr.��#are cc����d8red i�6e��tb�i�f�ar•t���3c�rt. Por�%�s of '
�he irr#arrrrafior�r»ay�ie.clas�i�ed as�ot��uhl�c i�'yflu pro�i�l���ec��re�ot�s f��#wau�d pe��t ti�e Clfy.�
c�o��/ctd�t�at the a�e trad�seL��, ..
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.gorrherstateonecall.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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State B ding Code must be completed within 180
days of permit issuance.
x /'!°l�� �i'�Y✓�1�� X
Applicant's Printed Name ApplicanYs Signature
Page 1 of 3
�
' ��?� �,���y �, �I DO NOT WRITE BELOW THIS LINE ���7�r�—
SUB TYPES
Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family)
� Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
Multi Deck Porch (Screen/Gazebo/Pergola) _ Miscellaneous
01 of Plex Lower Level Pool _ Accessory Building
WORK TYPES
New Interior Improvement _ Siding _ Demolish Building*
Addition Move Building _ Reraof _ Demolish Interior
Alteration Fire Repair _ Windows Demolish Foundation
Replace _ Repair � _ Egress Window � Water Damage
Retaining Wall 'Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation 3y �''v Occupancy c, �� MCES System `-'
Plan Review Code Edition i ' SAC Units "`
(25%_100%� Zoning /��� City Water
Census Code �34i Stories � Booster Pump —
#of Units � Square Feet — PRV "
#of Buildings 1 Length ,. Fire Suppression Required "
Type of Construction � Width -- .
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final/C.O. Required
Footings (Addition) , � , - �.` � Final/No C.O. Required
Foundation • . ,� ,.• � HVAC_Gas Service Test Gas Line Air Test
Roof:_Ice &Water _Final Pool: _Footings _Air/Gas Tests _Final
� Framing Drain Tile
Fireplace:_Rough In _Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick
� Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
. ,y,,.r'""✓f Other:
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee ,�O q ?�'
Surcharge
Plan Review 33t �
MCES SAC
City SAC
Utility Connection Charge
S&W Permit 8�Surcharge
Treatment Plant
Copies 1''S � '�d• d�.s — S�
TOTAL
Page 2 of 3
�
�. Use BLUE or BLACK Ink
�-----------------,
� For Office Use I
Cl� o��� �� � � 4 '
� � � Permit#:
� �� I
I
3830 Pilot Knob Road � Permit Fee: �
Eagan MN 55122 I �
Phone:(651)675-5675
� Date Received: �
Fax:(651)675-5694 � j
� Staff: �
��������_���_�_��J
2015 MECHANICAL PERMIT APPLICATION
❑ Please submi two(2)sets of plans with ail commercial applications.
� I // i � �pl �v� �Gt �
Date j /S Site Address:./ �G� ���C�d� � l' j��rS'%� 4��� .
Tenant: Suite#:
m..,,..,��, �.,,.�, r.�,� �_..� ...,,.,�e��mx ���
� Resident/Owner Name: Phone: �
, Address/City/Zip: /7� ��c�G.R-� ��i`� >2„ G`� �'Jn/ h?ri/. �j�/��;
� ������ ����
.� ��.�,,,a..a $
, / / - / ,
� Name: L-Gj.�l�i�.j' �' G fc�<<�,r4 �'�i� � License#: �..F�i�C���� �
(� (� �j �
� Address:d �a �� ��l�'�-2/ cf�'�. City:�����G:�/�
� Contractor � c�
� State:_���,�1/ Zip: �c!�Q �1 Phone:�.S~v� 6 �,� :.2 7�'c�
%/�'L. ��t'.ts' c+. �- ,v
:
K Contact: � 5' �... Email�C�.°< e-�'�..�✓' v �+" c�/�i�r_/—
�,_.�..��...�.,.,..��,��,;, �
� New �Replacement Additional Alteration Demolition �
� — —
Type of Work Description of work. �,�t� �'� � �
� NOTE;Roof mounbedand ground mounted mechanical equipment is required to be screened by City ;
� Code. Please con#act the Mechanical Inspector for information on permitted screening methods. �
�.�..
�,. �� ��
� � ,
� RES/DENTIAL � COMMERCIAL
� �Fumace � New Construction Interior Improvement
� � — —
� P@Plillt Typ@ —Air Conditioner _Install Piping _Processed �
� Air Exchanger Gas Exterior HVAC Unit �
` � _Heat Pump � _UndedAbove ground Tank �Install/_Remove)
�
� Other �
— �»�,��,,,,»�,..u���. _ ;
�RES/DENTIAL FEES `
�
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge �
� $100.00 Residential New, includes State Surcharge =$ � �- �� TOTAL FEE I
''COMMERCIAL FEES ,���,,� .�,�.N.u... ��,.,��..., _.��.�,,,ar��a.�n.s� � �I
Contract Value$ x.01 `
� $60.00 Permit Fee Minimum � I
� $70.00 Underground tank installation/removai =$ Permit Fee �
� Surcharge=Contract Value x$0.0005 -$ Surcharge ;;
£ If the project valuation is over$1 million, please call for Surcharge =$ TOTAL FEE �
�
�a.� .,��,.,�. °
�,�..,�,�,,� ,.�.�,.0.�-.. ��.,.,��,,,,�r��,�
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 ��� C �Z�V L. X .�
ApplicanYs Printed Nam A icant's Signature
FOR OFFICE USE
Required Inspections: Reviewed By Date:
Underground Rough tn Air Test Gas Service Test In-floor Heat Final HVAC Screening
r� �
t Use BLUE or BLACK Ink
� �-----------------,
' � For Office Use I
� . � o(�' I
���*T �� j����� I Permit#: �
y1 N_ I o� t
J �� � Permit Fee: i
3830 Pilot Knob Road i
Eagan MN 55122 I Date Received: �
I
Phone: (651) 675-5675 j �
Staff:
Fax: (651)675-5694 L________________�
` 2015 RESIDENTIAL PLUMBING PERMIT APPLICATION
,
� Date:�". 11,�'�' � ./S� Site Address.l7� ����,�'v,+L ����� �� � �,�n1 ��s�/, cS�,S �o��
Tenant: Suite#:
��� ��».ti.�..� ��,�.,,...m.,_- �.�„ ��
; ResidentlOwner Name: Pnone: �
� Address/City/Zip: �� !T-��'z` f`frl�J. �/d � �' ,%�/ � l�3-�--^
_�,,,..,� ��,
�,av,.� �Aa�„w
/ ��� �i ,
: Name:��;9/��J" ����2C�i ai/'4 �.r�c���T� License#: �G ��'�C�S 7 �
� Address: U UY� �� ��r'�'+/ c�� City: ,(}C!� t-Cq-�iie `
Contractor �
� State:�i�'i v., Zip: ������ Phone: �5�� ��� '— a �J�� �
� � Contact: � L�� � Email:Ll�'�v e !' � �i�'ow�'e w,vc� �eL" �
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� Type of Work —New �Replacement _Repair _Rebuild _Modify Space _Work in R.O.W. �
� Description of work:!/�y��"����� ���� ����` '
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RESIDENTIAL F
' � �Water Heater
� � �Water Softener
Lawn Irrigation(_RPZ/_PVB) �
� Pet't111t Type � Add Plumbing Fixtures(_Main/_Lower Level)
; � Septic System � ;
� _New Water Tumaround £
���� _Abandonment v y��� 4 �� ��r�� ;
, _ .... _.._.,« ,
4 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 Add Plumbing Fixtures, Septic Svstem Abandonment,Water Tumaround"(includes State Surcharge) �
� `1Nater Turnaround(add$210.00 if a 5/8"meter is required)
� $115.00 SeptiC System New(includes County fee and State Surcharge)
$ TOTA�FEES$_��.L� �
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. ww�v.qapherstateanecall.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 wil► be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
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ApplicanYs Printed Na p icanYs Signature
FOR OFFICE USE Reviewed By: Date:
12equired Inspections: ' Under Ground Rough-In Air Test Gas Test Final
Meter Related Items: Meter Size Radio Read Manometer Staff: