4134 Nicols RdCITY OF EAGAN Remarks * Cedar Grove Acguisition
Addition CEDAR CePOVE #1 Lot ATt9 Bik 7 Parcel 10 16700090 02
Ow?er??nf(+P. `v R!1'?(?jlfl A1P?`,eflP[Street 4134 ?Avenue State ?Qan, MN 55122
? ?-"4Ati
Improvement Oate Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWER LATERAL 1972 1,304.00 52.16 25 834.56 2 8 1 8
WATERMAIN
* WATER LATERAL 972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. . ?
BUILDING PER.
SAC
PARK
CITY of EAGAN
BUILDING PERMIT
Ownax ...1l. _..??...::57..4...................................
Addsecs (precen!) ....... &'I ". ...... .
...... ..................... .................
Sulldes ............... a .....?.Z?.....
Addraes ...............................
DESCRIPTIOIQ
r io
N4 3743
3795 Pilo2 Knab Road
Eagan; Minneaofa 55122
954-8100
Dele ..... . 1F ...?` .:- 7`r
..............................
cries To Be Ueed For son! Deplh Haig6i Eal. Coo! Pesmi! Fea Remarlts
7 ?? I
or
o..d
? I Wl Q
4 t
This permit does aoi authoriza the use of slreets, soads, alleps or sidawallcs aos doea it glve !6e owae: or Lfa agen!
the :igh!!o eseafa any siluatioa whieh is a nvisanee or which psesenle a hasard to the heallh, aafelp, coavsaience aad
general welfare !o aapone in the eommuniip.
THIS PERMIT MUST BE?1$EPT- -ONTHE? PRg7 MISE WHILE THE WOAK IS IN PROGAEI 18,
This ia to eesliiY. °.:`-?-.......................haepermisston !o eseo! `.----.. .......... ...................................... _upoa
the above described premise subjecS !o the p:ovisions of all applicable Ordinanees fos the Ciiy o Eagaa.
?.:....v..?:.-_:...........'_"'.......... Pes ....._'...'.........?...?...........?r:..`...r?
Mayor BuSldinq Inspeetor
A
EAGAN TOWNSHIP
BUILDING PERMIT
DESCRIPTION
N° 867
Eegan Township
Town Hall
Date _8// /6?}.,
...........................
Sioxies To Se Used For Froni Depth Heighi Esf. Cosf Permit Fee Remarks
v LOCATION
Slreei, Road or other DescxipSion of Loeation Lo! Block Addi2ion or Traa!
This permit does not aulhoxise the use of sireeffi, roads, alleys or sidewalks nor does ii give the owaex or his agent
the right !o ereaie anp situation which is a nuisance or which presen3s a hazard io the healih, safeip, convenience and
general welfare fo anyoae in the commuaiYp.
THIS PERMIT MUST BE KEPT /N/ TH?E PR?EMISE WHILE THE WORK I5 IN PROGRESS.
This is !o ceriifp, lhai...406 ....ro------------------has pesmission !o eseei a.--."'- -"'_---"---'-" -
!he above described premise subject fo the pravisians af the Building Ordinance foz gan Township adopled April II,
1955. v )
-'-`-°--'--.....--. ....?..
Chairman ot Tnwa Board
Per ----------------------- tz'.,'_'--'-?!..r".._..-.'..-?--•`-.....
--..
? Building Inspecior ?
?
CITY OF EAGAN PERMIT
3830 Pilot Knob Road PERMIT TYPE:
Permit Number: B U I L D T N G
Eagan, i,qinnesota 55122-1897 0341.45
(651) 681-4675 Date Issued: 12 / 0 2 19 8
SITE ADDRESS:
413/1 uzcrLs Rn
Lor: 9 t;LOcK: 2
CEDAR GROVF #i?
P.7.Pd, : 10 -1.67698--040-02
DESCRIPTION:
t? T.O. --_ & KEkOoF
6u??ldifig '{??.miT Tyue
Br;Iik£liYtg Wia~t'1;`Type
42nsU8 GcTCde..
__.•,`
/
STURM DAMAGE
REPAIR
434 ALT. RESIDENI":CNt.
C i 3
r` tgf i"`,
r.r u-
REMARKS:
FEE SUMMARY:
CONTRACTOR: - AD Dtir.ant - Sr.. ?.1c. OWNER:
TQP L1NE CONS`1" & RC?qFIP16 143289?3F3 ',?.?i1.f?2247 hIESSETLER GEORGE
14541 E`,/F;iGRFF-IE! TR 4134 NICOLa f2D
APPLE VALLLY MN 55124 r.AGflN MiV 55123
(612) 432-8998 (651.)454-7373
I
Z harebw acftnow,3edge that I have read this appla.cati.on and stat2 that tFie
information, is carwecC and' acir€e to oomplv wi.th a111 applicable 5tate ai' hln.
5tat'utes and C3ty bt Eaaan Ord...inanGas.. .. .
? . _ . .... .. _ . . . . . . ..
APPLICANT/PERMITEE SIGNATURE ISSUED BY: SIG TURE
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT IQN0B RD - 55122
681-4675
New Canshuction Reauirements
? 3 registered site surveys
?2 copies of plans (includa beam 8 window saes; poured fid. design; eDC.)
? 7 energy calculations
• 3 eopias M trae preservadon plan H bt platted aRer 711f93
reQUired: _ Yes _ No
DATE: / ?- p 7
RemodeUReaair Reauirements
? 2 copbs at plan
? 2 site surveys (exterior aAdRions & decks)
? 1 energy calala6ons for heated addkions
CONSTRUCTION COST; ? p?a ou
r .. .
DESCRIPTION OF WORK:
S lovrM
STREETADDRESS: `7 /,3`f N(CGIS /YCJ U V
LOT: O? BLOCK: ?-- SUBDJP.I.D. #: Q?1 0.,? G r Uv
--?
Name: NeSS??/21 VC:,o??J Phoae#: aSl -YJq ~ 7 373
PROPERTY 1.ssc First
OWNER Street Add_Wss:413q A1Cal,S A
c;y Stau: z;p: SS/?3 Company: dw, " Phone #: 0- 4/3l-?g
CONTRACTOR /J/??/
5treet Address: / 7,7`?1 / u ?? ee_Yl ! ? • License # G
CiTy State: AW Zip: 55 ?a7
ARCHITECT/
ENGINEER Company: Phone #:
Name: Registration #:
Street Address.
City State: Zip:
Sewer & water licensed plumber (new construction ony): . Penalty applies when address chang
and lot Change is requested once permit is issued.
I hereby acknowledge that I have read this applicadon and state that the iniortn tio is co an agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances. ,
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Trae Preservation Plan Received _ Yes _ No _ Not Required
qo5 fl 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 33122
851-881-4875
New Conshuctlon Reaulremenh RemodeUReoair ReaWremenb
> 3 reglstered sife wrveYs showing sq. H. of lof, sq. H. of house
and gl rooled areaa l? (20% mmcimuan bf coveraae olbwetl)
> 2 coples oi plana (show beam A wlndow aizes; poured 1nd. deslgn; efcJ
> 1 set of energ calculallons
> J coples of h e preaervatlon plan if IW plpMed afFer 7/1/43
DATE:
? 6?3 , -a-a
2 copies W plan
1 sef ol energy cdcWatlons lor heatetl addiHans
t s8e wney tor exleAor oddlnons & decks
ea
CONSTRUCTION COST: Onv? --
DESCRIPTION OF WORK: ? S'?u ? ?q
STREET ADDRESS: "? 1->"1 + ?«Gwt-5 V-o^v
LOT: 9 BLOCK: 0 SUBD./P.I.D. #:
Name: ?Acs3 C i L'E2. cfoc_?IaE Phone #: l?? ySN ????3
PROPERTY Laat FIM
OWNER
Sheet
C
Ciry State: zip; SS( ZL
company??RO"?•Z4- 7?rve.01-?o-4 ?c. Pr,one r: CtL T82-9y.73
(area code)
CONTRACTOR
rneeraacuess: ll(\ 7--- LL.-tr-'P T-9 ucenseaz0060313 Ep,3 31Li
Ctly l?v^1-,..? 5 v i LLE stote: l-`'tl up; Ss'33 1
ARCHITECT/
ENGINEER Company: Name:
Telephone ?1: ( )
Sheet Address: Regishaflon #i:
Ciy state:
SeweNwater licensed plumber
1 hereby acknowledgeIhat I have read ihis applicalbn, sQate thaf ihe infortnation b
of MinnesAta Stalutesand CNy of Eagan Ordinances. I
Signature of Applicanf
OFFICE USE ONLY
Certificates of SurveyReceived
Yes No
ZiP:
Phone #: U
, and agr to comply wMh all app6cable StatE
Tree Preservation Plan Received - Yes - No - Not Required
OFFICE USE ONLY
BUILDING PERMiT SUBTYPES
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 08 06-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 03 01 of _ plex ? 09 07-plex ? 18 Deck ? 23 Porch (screened)
? 04 02-plex ? 10 08-plex ? 19 Lower Level ? 24 3torm Damage
? 05 03-plex ? 11 10-plex Plbg _Yor_N ? 25 Miscellaneous
? 06 04-plex ? 12 12-plex ? 20 Pool ? 30 Accessory Bldg.
? 31 Exc. ac - Muni
O 33 Ext. Aft - SF
? 36 Mutti
woRK nrPE
Q 31 New ? 36 Move Bidg. ? 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)" ? 44 Siding
? 33 Alteration ? 38 Demolish (interior) 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors
• Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code ? # of Stories sq. ft.
No. of Units d Length sq. ft.
No. of Buildings
(Act
al
t
C Width
ft
Basement s Footprint sq. ft. ?
Census Ende
)
ons
.
u .
q.
(Allowable) Main level sq. ft. MClES System
UBC Occupency ` I sq. ft. City Water
Zoning sq. ft. Booster Pump
PRV
Fire Sprinklered
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
% SAC
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
?-- 4 o o 13
CITY OF EAGAN
3830 PILOT IaIOB RD - 55122
651•881-4875
406
v
? S reglatered slte wroeys ehowlnq fq. tt of bt, aq. ft. of housa 2 copies of plan
antl gQ rooled oreas (40X nwx)mum bt covemce allowed? 1 set of energy calculWiona for healed addtflons
D 2 caples of plara (show 6sam & window sizas; poured 1ntl. tleaign; etc.) t site wrvaY for extedor addlHOm & de?cks
D 1 sef W energy calculaNons ? JG'O?? =
D J copiea of hae aervplan tl lot patfed aRer 7/t/99 ?
DATE: 3 ?ZZ?("?C) CONSTRUCTIONCOST:
DESCRIPTiON OF I
STREET ADDRESS:
LOT: L7
Name: ` ???r-'-uQ- C_sf OLQ-x-- Phone
PjOPER7Y L(pl FIKI
OWNER
y134 l4«q1L
Ciy state:'Uv`-? Zip; Srlu-
Company??01'X1C?L PhoneM: 612 382-943
CONiRACTOR
city? Qz--S 1) 1 U-C_ stare:
State:
ARCNITECT/
ENGINEER Comparry: Name:
Telephone #: (
Sfreet Address: Regis7aMon #:
citY
Sewerlwater licensed
I hereby acknowledge ttwl I have reaq thls applicalion, atote fhat ihe
of qlinnesota Statutes and Gly o} Eagan Ordlnances.
Sigrwlure of Applicanf:
OFFICE USE ONLY
Certiflcates of Survey Received ,
Tree Preservation Plan Received `
Yes _ No
Yes _ No
Is
(area code)
tJcenseM zob6o3'13 Exp,31?7 ?d1
21p:
Zip:
act, a agree to comply wNh ad appOcabfe Sfafe
_, Not Required
BLOCKi v SUBD./P.I.D. M: Ct d a r 6 r0 Vt *Egrw- it 1-
' RESIDENTIAL BUILDING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 9 651-675-5694
syq' 75
New Canshuction Reauiremenfs RemodeUReoair Reauirements Offce Use Onlv
3 registered site surveys shrnving sq. R of lot, sq. fi. of house; and all roofed areas 2 copies of plan Cert of Survey Recd _ Y_ N
(20°h maeimum lot coverage allowed) 7 set of Energy CalculaUons for heated additions Tree Pres Plan Reod Y _N
2 copies of plan showing beam & window sizes; poured found design, etc. 7 site survey for additions & decks Tree Pres Reqd Y _N
lseto(EnergyCalculations Add'rtion - indicateHon-sdesepNcsystem On-siteSeptlcSysiem _Y _N
3 copies of Tree Preservation Plan if lot platled after 711193
Rim Joist Delail Options seleUion sheet (bidgs with 3 or less uniLs
/y
3()
v
?
1,
Date / Construction Cost
Site Address r1
q!,3 `7 /? I C D (?
lS Ko F4 C( UniUSte #
Description of Work BC1 S P VY) P N 1' e G(isSS L')l?1 dOC.t)
Multi-Family Bldg _ Y rg?) Fireplace(s) 1 _ 2
Property Owner CCj f Is (D A) Telephone # ((oSl ) L4 S14 `7 3 -7 3
Contractor rk I e C ONC eP TS ! rl) G
Address .S 73 g /v lCo l l e f AJ S O City I`Yl p(S
State frlrj Zip SS ?f fq Te?ephone#((oIa) 861(0 a3113-
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy COde Category , Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
. Energy Envelope Calculations Submitted
Have you previously
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
#(
N If so, 25% plan review
I hereby apply for a Residential Building Permit 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 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; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval ofplans.
i? ?g1?nl?ith a similar plan?
n I S 0 T T 21thone hone # r o 12003 #(
,
RoGC r \AZ.,,--c
App fcanYs Printed Name Applicant's 'gnature
OFFICE USE ONLY
Sub Types
,
? Ot Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) X 33 Eut. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
O 33 Alteratlon ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 dows/
Doors
W
in
,
f
c
f
?
r
? 34 Replacement 'Demolition (Enttre Bldg) - Give PCA handout to applicant ?/
'
J
Valuation d(J l Occupancy /Z' -3 MC/ES System ' -
Census Code Zoning /2' ( City Water -
SAC Units - Stories ? Booster Pump ---
Nbr. of Units - Sq. Ft. r PRV --
Nbr. of Bldgs Length -- Fire Sprinklered -
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings(deck) FinaUNo C.O.
_ Footings (addition) _ Plum6ing
Foundation HVAC
Drain Tile Other
Roof Ice & Water Final Pool Ftgs Air/Gas Tests Final
? Framing Siding Stucco Stone _
Fireplace RL Air Test Final x- Windows (new/replacement)
Insulation _ Retaining Wall _
Approved By
Base Fee
Surcharge
Plan Review
MCIES SAC
City SAC
Utility Connection Charge
S&W Permit 8 Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
A-vy 40 ,34a/W:rJ ?vy?`
?
? eoiorrceuse ---- -1 ?
j Permit #:
? Permit Fee:
? DateReceived: 7,2J I
I Staff:
I
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Oate: ?-?,. 2?l u?il? Site Address:
Tenant:
Suite
RESIDENT/OWNER ^44"4 zs,`$
Name: /7I'i G'j ?r
Phone:
1
/
1 ( 7 ( ?" ? `S
Address ! City / Zip: /
Applicant is: ? Owner _ Contractor
TYPE OF WORK Description of work: TL0.T dfC
Construction Cost:525 06 Multi-Family Building: (Yes No ?
CONTRACTOR Name: License il:
i?
Address: ?
City: State: Zip:
Phone: Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Efl@fgy COd@ • Residential Ventilalion Category 1 Worksheet ? New Energy Code Worksheel
CetegOry Submitled Submitted
(4 submission type) • Ener9y Envelope Calculations Submined
In the last 12 months, has the City of Eagan issuAd 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 Contrector: Phone:
Sewer & Water Contractor: Phone:
NOTE: P/ans and supporting documents that you submit are considered to be public information. Porteons o/
fhelntormation may be classlfled as non-public if you provide specific reasons that would permit the Ciry to
canclude that the are trade secrets.
I hereby acknowledge ihat lhis iniormation is complete and accurete; that the work will be in conformance with the ordinances and codes oi the City of
Eagan; that I understand ihis is nol a permit, but only an application for a permit, and vrork is nol to start withoul a permit; Ihat the work will be in
accordance with the approved plan in the case ot work which requires a review and approval plans.
J611 mG1414?1w?_ x
ApplicanYs Printed Name ApplicanYs Signature
Page 1 of 3
Use BLUE or BLACK Ink
r—————————————————� _ _ .
I For Office Use '���-
� ii i
Clt0��� �Il � Permit#:� 3� (�� I��"�-
� � � I
I �_ �� i
3830 Pilot Knob Road � Permit Fee:
Eagan MN 55122 � I
Phone: (651)675-5675 � Date Received: �
Fax: (651)675-5694 I �
� Staff: �
�-----------------�
2015 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2)sets of plans with all commercial applications.
Date:� ��'�� �� Site Address: I � � � ������j ✓'=�'1
Tenant: Suite#:
b��"� " � �� o � �
y� Name: ���"`�> E' ��� • Phone: '
���IC������:�`
' �� ;' �y ` Address/City/Zip:
� �
v � )Q >
`��` ,�" ,.� � ��G�' �c. License#: � �U c� ( �� �
Name:
' �� '
�;�y � ��G, Address:�ld�U J 7 "'.��` .� City: ��,�l�
�'ii�t1����Q1"
State: /� Zip: -�.3�� Phone: �S�" 2 3..5�;' a p��-'!�
_:� Contact: ���- Strc.��� EmaiL• ^ �z.� �ofl-G I'�
,
��
��` �
� . ����,�� New �Replacement Additional Alteration Demolition
�" �� _""; _.__ ��� /� �
T ��f 1Nt��`l� ' ` Description of work: GS c� �- /r�t�'h� C-C>
Yp ,����
.
�� � �,��� t��3T�. Rc�r�f nnc����+d a�d c�r�aur��!r���nted me�iiariical�������t�s re�c�d#c��e s+�r���d k�y G� ':
, -, �� 3�� �a *� _ . .... . .,. . . ����r`�`���� ��'���.�i �� �.
� ��nt��. .Fiease ccr��a�t th�Mectiar�i�al in�pi�r,ctar for inf�irr��t��s�� P�r�; . . �� k �,
� ,;;
��.-: ,.�...
�� � ��������` RES►DENTIAL COMMERCIAL
� Furnace New Construction Interior Improvement
i ��� ��� —
���� F ; _Air Conditioner Install Piping Processed
P+�2Kr�t���[��
` `� �,,..., � . : Air Exchanger Gas Exterior HVAC Unit
; _Heat Pump Under/Above ground Tank �Install/_Remove)
_
;: � _Other
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
COMMERCIAL FEES Contract Value$ x.01
$60.00 Permit Fee Minimum, includes State Surcharge
$70.00 Underground tank installation/removal =$ Permit Fee
'`If contract value is GREATER than $2,010, Surcharge=Contract Value x$0.0005 -� Surcharge"
If the project valuation is over$1 million, please call for Surcharge =� TOTAL FEE
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 �� � X �
Applicant's Printed Nam ApplicanYs Signature
��F����tG�sF�,�� � �: ������� � ' �����`�����
� � �
R�qu�r��f�tts����ns �� � �� Re�ri�vve�l By ; ��,> l3�t�
� �� ��� �� � � ���� , EE
��o� ..:
tJri�r���r������ . ' I��i�r�n `,,,�„�„Arr"Te� `��� Gas�eru�e�7�st ' Irr',�lac�r Heat ` ' �in�i U��5cr��ar��
,_... . �'x ,.... ,.�,,..,,.. �F�
��.... ���.F...
Use BLUE or BLACK Ink
r----------------�
I For Office Use �
� ` �_ ''j I
Cit of �� �� j Permit#: ����+�°� .J I
Y � � � �;� �
� Permit Fee: �
� I
3830 Pilot Knob Road � i
Eagan MN 55122 � Date Received:' �
Phone: (651) 675-5675 � �
Fax: (651) 675-5694 I Staff: �
�-----------------�
015 RESIDENTIAL PLUMBING PERMIT PLICATION
Date: i�� J �� Site Address:�� � �f � V ) CO ) � �
Tenant: Suite#:
�esitl�eratlO�nrner " Name: Pnone:
Address/City/Zip:
��� Name: �� � ���� 1�'l License#:
„� ? ,; . . ,
Gt1i'��r'aCtOC Address City:
State: Zip: Phone:�r� `��'+�/y � �r�ci
Contact: Email:
����,Q����,� _New �Replacement _Repair _Rebuild _Modify Space _Work in R.O.W.
Description of work: f �N �!le - L��J—�� C�P S t,C'C�
RESIDENTIAL C6ytrtec �c.�s �j f�n��
Water Heater
W ter Softener
Lawn Irrigation(_RPZ/_PVB) � �
P����#���� �" ✓ Add Plumbing Fixtures(,�Main/_Lower Level)
Septic System
New Water Turnaround
Abandonment I
RESIDENTIAL FEES: I
$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 Turnaround"(includes State Surcharge)
"`Water Turnaround(add$210.00 if a 5/8"meter is required)
$115.00 SeptiC Svstem New(includes Counry fee and State Surcharge)
TOTAL FEES$
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.qopherstateonecall.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 sta t 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 Appl' Ys gnatur
FC)R OFFICE USf ; Reviewed By: Date:
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