3653 Windtree Ct- PL91730RESIDENT OWNER
Name: Lc't- W cd S Phone:(b-S 2 /5 S/ O 3
Address City Zip: 39 L/4- 1' M it)
CONTRACTOR
Name: 1 (4 ef 1 L K C._ License
Address: 011-1/ AV S 3
City: A)' ?Ifni i State: gf' Zip: 37,0 -7
Phone: x' 9- 7 51 I Contact Person: 4` t ie 7 L 2--
TYPE OF WORK
New Replacement Repair Rebuild Modify Space Work in R.O.W.
Description of work: 7 .e ,P to C...Q it 4 e o c: X -cA 1 eS j■-0C-CareDys.
PERMIT TYPE
RESIDENTIAL
Water Heater Water Softener
Lawn Irrigation x Add Plumbing Fixtures
RPZ PVB) Main Lower Level)
i
Septic System Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation
$50.50 Add Plumbing
*Water Turnaround
$100.50 Septic System
$90.50 Fire Repair (replace
(includes $.50 State Surcharge)
Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge)
(add $165.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2009 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date. 1%ii i °CCP Site Address: 310. s v d r e Cam'
Tenant: kiIrfo Suite
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance wit
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to sta
accordance with the approved plan in the case of work which requires a review and approval Ian
x griit e-vi Vi% z
Applicant's Printed Name
FOR OFFICE USE
Required Inspections:
x
App ica is Sig
Permit
Permit Fee:
Date Received:
Staff:
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
the
Reviewed By: Date:
Under Ground _Rough -In _Air Test _Gasr Test Final:
ut
Use BLUE or BLACK Ink
1
J
rdinances and codes of the City of
permit; that the work will be in