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3889 Serpentine Cir CITY OF EAGAN Remarks- SAW & WtY' CCpltl. pd.11 -14----b8 Addition Cedar Grove #6 Lot 9 Rlk 6 Parcel lo 16705 090 g6 Owner,nkA UkYhQY(A IJJ~7IA'riStreet 3889 Serpentine Dircle State Eagan,MN 55122 ~ Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 5TREET RESTOR. GRADING SAN SEW TRUNK SEWER LATERAL 7 970 72.00 20 P11d WATERMAIN *WATER LATERAL O 20 WATER AREA # STORM SEW TRK 1970 20 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 200.00 1072 11 -20-68 BUILDING PER. sAC 200.00 1072 11 -20 PARK INSPECTIUN RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: 0'~ aH Eagan, Minnesota 55123 - ~ Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT: N t TiYE CTR "Ni i, ;'ri ~.i N11111 1I rJl, i N( : J iitkl ; u 4,. ! , . 00. 61 PERMIT SUBTYPE: TYPE OF WORK: INSPECTION DATE INSPTR. INSPECTION TYPE DA ; t~1F1~ I Permk No. Permk Ho{der Dete Tetephona i S/1N PLUMBING HVAC EIECTRIC ELECTRIC Inspect{on Date Msp. Commerrts Footi?gs I Foundation Framing Roolin9 Fough Plbg_ v, Ftough Isul. Fireplaee Fnal Heg. Orsat Test Finel Plbg. Plbg. Inspector - Nati(yr Plumber Const. Meter EngrJPian &dg. Flnai Dedc Ftg. Deck Final wen Pr. Disp. I CITY OF EAGAN j~~~ 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 19347 ~ PHONE: 454-8100 ' BUILDING PERMIT Receipt • i ~t' ~ j To be used for ~~M IORCO Est. Value ~3~000 Dale 'rULY ZO 19 91 Site Address 3W9 8RPOTilli C1RCLZ OFFICE USE ONLY Lot 9 Block 6 SeciSub. CZDAR aRYL 6 Parcel No. occuPancy _ FEEs zoning W Name JOdll 8 JEAN DtllQOLL (Actual) Const _ Bldg. Permit ~ ; AddreSS swM (aiowable) _ 1 0SO p Surcharge City Phone be1-0sbi # oi stories Length 12 Plan Review o Name aAM ~M o b i~~ ~ a s- a y n"J Depth ~ snc, cicy 0~ Address S.F. Tocal _ City Phone S.F. Footprints _ SAC, MCwCC F On Site S ewage ~Nater Conn Name On Site Well water Meter ddr('SS MWCC System City Phone Cily Water _ Acct. Deposil PRV Required _ S/W Permit I hereby acknowlege that I have read this appliCation and state that the Booster Pump - SMI Surcharge intormation is correct and agree to comply with all applicable State of Minnesota 5tatutes and Ciry IFagan Ordinances. Treatment PI Signature of Permitee ~APPROVALS Road Unit JON A Building Permit is issued to: a~~ DRIsWLL Pla""ar - Park Ded. an the express condition that all work shall be done in accordance with atl Council 2.30 applicable State of Minnesota StFAutes and City oIi EagaR qrdinances. gldg, pn. Copies Building Official ? Variance - TOTAL ~ 1 Permit No. Permit Holde? DaN Talephone # WATER Y SEWER PLUMBING H.VAC. ELECTRIC Inspeetbn Date Insp. Comments Footings 1z 7 yi ps Fourtdation Framing j-q,~ . 1i e4l vs NP-Y v Rooting Rough Plbg. Rough Htg. Isul. FireplaCe Final Htg. Orsta[ Test Final Pibg. Plbg. Inspector - Notify Plumber Const. Meter EngrJPlan Bldg. Final ~ De ik Ftg. Oedt Final weli Pr. oisp . CITY OF EAGAN No . ~ 939~ 3830 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55121 J BUILDING PERMIT PHONE:454-8100 Receipt # To be used for SCREEN PORCH Esc Value $3,000 Date JULY 1D 19 91 Site Address 3889 SERPENTINE CIRCLE Lot 9 Block 6 Sec/SubCEDAR GROVE 6 OFFICE USE ONLY . PBfCQI N0. Ocnpancy - FEES Zoning W Name JOHN & JEAN DRISCOLL (AClual) Const _ Bldg. Permi[ $ 54.00 3 Address SAME (Aliowa6le) _ 1.50 ~ City Phone 681-0564 s oi stodes su~cna~9e Leng[h 12 Plan Review io Name SAME DeDih 12 SAC,Ciry $Q Address S.f. Total - SAC, MCWCC ~ (~.11y PhOf18 S.F. FoolpriMS - On Sim Sewage _ Water Conn r ~ W Name On Site Well ~w - WaterMeter Address MwcC Syscem a W Ciry Phone Ciry Water _ Aoct• Oeposit PRV Required - SNJ Parmit I hereby acknowlege that I have read this application and slate that the Booster Pump - S/yy Surcharge inlormation is correct and agree to comply with all applicable State of Minnesota Statutes and Ci~1y~ ffg~an /Ord/Ri nces, d Treatmenl PI d~l~i~~ ~LGi APPROVALS Si9nature af Permitee d qoad Unil A Building Permit is issued to: JUHN & JEAN DRISCOLL Pianner - park Ded. on the express condilion thal all work shall be tlo in accordance with all Council 2.50 applicable State ol Minnasota SI es and City aqaq dinances. Bldg. Off. _ Coqes ~ r 58.00 Building Oflicial Varience - TOTAL S EAGAN TOWNSHIP BUILDING PERMIT N° 1897 Owner Eagan Township Address (Preseni) ._~._.-_........=•.•_::1l....~-~----~-------------------- Town Hall Suilder ~°z jlG Dale Addresa ~ DESCRIPTION 5fosies To Be Used For Fronf Deplh Heigh! Esl. Cos! ~Permit Fee Remarics ~ ~7 il..~-c ~oS-P•--= ~ o' ,~d ? LOCATION .3-o G~zz4z Sfreel, Road or ofher Descripiion of Location Lo! Block Addifion or Traci This permii does not auShozise the use of sireels, xoads, alleps or sidewalks nor does it give the owaer or his agenf the righS io creale any siiuaiion which is a nuisance or whieh presenls a haaard !o the healih, safeiy, convenience and general welfare !o anpone in the eommuniSy. THIS PERMIT MUST BE KEPTq,ON TqHE PAEMISE WFIILE TfiE WOAK IS IN PROGAESS. This is fo vezfify, Sha2..... P.._..!~:.......! . ----.-........has permission fa eree! a..... _..~~r. u on - - p the above desaribed premise subjea! !o the provisions of the Building Ordinanoe fas Eagan T~sh3p ad fed April 11, 1955. . ti' ~ ~---~r~va........... Per _ .............--.~4 .4.x.........~ ~ Chairman~ Tnwn Board ~ Building ~nspecfor Q '6 2004 RESIDENTIAL BUILDING PERNIIT APPLICATION City Of Eagan -t- t-7 ~ U~ 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Consirucfion Reauirements RemodeVReoair Reouiremenis i~e~~Se~N7 3 registered siie surveys showing sq. N. of lot, sq. ft. of house; and gJI roofed areas 2 xpies of plan Cad es+,X N (20%maximum lot coverage allowed) 1 sef of Energy Calculafbns (or heated addifions II2m0 CCSI'~n';Recd -_.Y _N2 cnpies of plan showing 6eam & window sizes; poured found design, elc. . 1 site survey for additans & decks 1 set of Energy Calcula6ons Addm'on - iridicate if on-site sepfic system Orisite 3ept~c SystBAt _ Y _ N3 copies of Tree Preservatbn Plan if lot platled aHer 711/93 Rim Joisl Detail Opiions selection sheel (bldgs with 3 or less units Date /0,3Construction Cost Site Address -M,62 UniUSte # Description of Work Multi-FamilyBldg _ Y_ N Fireplace(s) _ 0_ 1 _ 2 Praperty Owner T ,vNify /c Telephone # VS/ 4Sa 214S~ Contractor W~3 k~- l Address 1~~ ~ ~„~rw Av~ 1u City &~oDn cA State eo Al ZiP 53~¢/ Telephone # Qd"3 )$Q/ COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Yvlinnesota Ruies 7670 Cateeorv 1 _ Minnesota Rules 7672 Energy Code Category . Residential Ventiiation Category 1 Wwksheet • New Energy Code Worksheet (J submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 257o plan review fee applies. Licensed Plumber Telephone ) Mechanical Conhactor Telephone ~ Sewer/WaterConfractor Telephone S!!!accurate; I hereby apply for a Residential Building Permit and acknowledge that the info ' 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 pemut; that the work will be in accordance with the approved plan in the case of work 'ch requires a review and approval of plans. Applicant's Pnnted 1 ame Applicant's Signature OFFICE USE ONLY Su6 Types ? 07 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Ait- Multi ? 03 01 of _ plex ? 09 07-pleac ? 17 Garege ? 22 PorchlAdda (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-ptex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-pleac ? 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 Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant Valuation Occupancy MCES System Census Code Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS _ Foollings (new bldg) _ FinaUC.O. _ Footings(deck) _ FinaUNo C.O. _ Footings (addition) _ Plumbing Foundation HVAC ~ Drain 1Yle Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final _ Framing _ Siding _ Stucco _ Stone _ Brick _ Fireplace _ R.I. _ Air Test _ Final _ Windows _ Insulation _ Retaining Wall Approved By: , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Pertnit 8 Suroharge Treatment Plant License Searoh Copies Other Totai ~ , ,PERMIT CfTY OF EAGAN `~3} 7 3830 Pilot Knob Road PERMIT TYPE: Eagan, Minnesota 55123 Permit Num6er: (612) 681-4675 Date Issued: ,i SITE ADDRESS: 10.: " rLCL~- b ~'.I.Ontt ?;?t0`:~1 e: f il _ I..... b/~~)5lh9'9 R~ DESCRIPTION: i ~ ~ ~ ~ ti.~ . ~ _ . . . . REMARKS: FEE SUMMARY: v h i u r, (j l~: 7o I e a ~ '~'y CONTRACTOR: OWNER: 6 tlTL:'tP' Nl~ ]PIC 1, S!-~ii110~0 o 01) !4'"hi1dPOL I , _Pi . ..by .I:-_ . liwv~ r.li,~ . ~ ;.c~ l. . . . ~ 0, rm.r, . i"J ..,y;~;.c. _o -o:::)'v . _ . . ~ . . ~ - nuo APPLICANT/PERMITEESI URE ISSUED V: IGNAfiSIRE'k INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: ' Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT: -X 17.?~ :TI~ '1'4~-fl Cr`.N Irht~;U1) f I. b;(, .iC 6i'.0 `J( 11 (hl7j '74iY() PERMIT SUBTYPE: TYPE OF WORK: :;r rPSIS~~ ; RC=1~liCf• INSPECTION D. • DA F L. PERMIT # CITY OF EAGAN / REACTIYATE , 1992 BUILDING PERMIT APPUCATION 681-4675 SINGLE 3 MULTI-FAMILY 2 sets of plans, 3 registered site surveys, l copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies when typing of permit is requested, but not picked up by 1'ast working day of month in which re uest is made or lot chan e is re uested once ermit is issued. Date Va/l uPon- of work V~) U Site Address: STREEt SUITE t. Tenant Name: (commercial only) IAT BLOCK ~ SUBD. P.I.D. M lRG r~ Descri tion of work: The applicant is: ? Owner Contractor ? OtI12P (Deseribe) Name ce ll Phone Property LA5, FIRST 1 Owner Address ~-2'~ a,,~L STREET STE N CitY 4W State Zip Company yi "cea_x Emocyrklcx ' Phone -ODzU Contractor Address 60 XX " Li / cense aU~v Exp. City _ "V7"du~ State ~ Zip 7 ArchltecU Company Phone Engtneer Name Registration N Address City State Zip Sewer 8 Nater licensed plumber . Processing time for sewer 8 water permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the information is torrect and agree to comply wi all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Appllcant: ~`k0.~`~=G OFFICE USE ONLY . . BUILDING PERMIT TYPE ? ,.,r 01 Foundation ? 06 Duplex ~ 11 Apt./Lodging 1°Base, .men; t F i n i s h ? 02 SF Dwg. O 07 4-Plex 11 12 Multi. Misc. ? 17 Swim Pool ? 03 SF Addition O 08 8-Plex O 13 Garage/Accessory ? 18 Comm./Ind. O 04 SF Porch . ? 09 12-Plex ? 14 Fireplace 0 19 Comm./Ind. Misc. ? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck O 20 Public Facility O 21 Miscellaneous WORK TYPE ? 31 New ? 33 Alterations ? 35 Tenant Finish ? 37 Demolish O 32 Addition 4 Repair ? 36 Move GENERAL INFORMATION Const. (Actual) . Basement sq. ft. MWCC System (Allowable) lst F1. sq. ft. City Water UBC Occupancy 2nd fl. sq. ft. PRY Required Zoning Sq. Ft. total Booster Pump N of Stories Footprint Sq. ft. Fire Sprinkler length 0n-site well Census Cade Depth On-site sewage SAC Code APPROVALS Planning Building Assessments Engineering Variance REQUIRED INSPECTIONS ? Site ? Footing p Framing O Insulation ? Mallboard ? Final O Draintile ? Fireplace Permi t Fee ~0 0 v,i,mt;,,,, Surcharge Plan Review License MWCC SAC City SAC Water Conn. Water Meter . Acct. Deposit S/W Permit S/M Surcharge Treatment P1. Road Unit Park Ded. ' Trails Ded. CoPies Other ~ Total: SAC % SAC Units MEMO 4~~ _ city of eagan T0: aiANE DdWNS, UTILITY BILLING CLERK FROM: ED KiRSCHT, SR. ENGiNEERING TECH DATE: AUGUST 25, 1993 SUBJECT: STREETLIGHT ENERGY COSTS CEDAR GROVE NO. 6(141 LOTS) This memo is to inform your department to begin to invoice the energy costs at the single family rate effective August 1, 1993 to the property owners in Cedar Grove No. 6 Addition as listed below: Block 1, Lots 1 1 Block 2, Lots 1-8 8 Block 3, Lots 1-18 18 Block 4, Lots 1-11 11 Block 5, Lots 1-9 9 Block 6, Lots 1-53 53 (Lots 54 through 61, Block 6, should not be billed at this time) Block 7, Lots 1-12 12 Block 8, Lots 1-18 i$ Block 9, Lots 1-11 11 TOTAL 141 The City is currently being billed by Dakota Electric for streetlighting in the above listed subdivision. 42L Ed Kirscht Sr. Engineering Tech cc: Mike Foertsch, Asst. City Eng. EK/je _ ' _ _ _ _ ; EAGFN TOWNSHIP ~ 3795 Pilot Knob Road ~ St. Paul, Minnesota 55111 Telephone 454-5242 PERPIIT FOR WATER SERVICE CONNECTTON Date: Numner: 149 (~,~~t/ i Billiag Name: YI i.rV Site Address:c'~p`~o c3VP~ n 7C l~ Owaer: ~AYee~,¢l' Billing Address Plumber:c91-~• ~ - j ~ Location of Connectioa Meter Size Connection Chg. ' Meter No. Permit Fee 7.50 ; Meter Rezding Meter Dep. , ~ Meter Sealed: Yes Add'1 Chg. NO Total Chg. Inspected by ~ Date ~ li Building is a: Remarks: ~ , . Residence ~ . Multiple No. Units , Commercial Industrial By: i = Chief Inspector i Other In conaideration of the isaue and delivery to me of the abwe permit, I hereby agree to do ttv proposed work in accordance with the rules and regulatioas of Eagaa Township, Dakota County Minnesota BY: PLease notify the above offica when ready for inepection and connection. i . ~ ` a EAGAN TOWNSHIP 3795 Pilot Rnob koad St. Paul, Minnesota 55111 Telephone 454-5242 PERMIT FOR SEWER SERVICE CONNECTION DATE: • I3y Iq NUNIBER 266 OWNER:r..~&V Addrese Lw,a.A.:~~11e, PLUMBBR TYPE OF PIPE DESCRIPTZON OF BUIIDING Industrial Commercfal Residential Multiple Dwelling No, of units ~ ~--r~ Lacation of Connectiona: Conaection Charge a~~• Permit Pee 7•50 Street Repairs Total Inspected by: Date Remarka• By Chief Inspector In consideration of the issue aud delivery to me of the above permit, I hereby agree to do the proposed work in accordance with the rules and regulations of Eagan Township, Aalcota County Minaeao[a sy ~C, Please notify when ready for inspection and connection and before any portioa of the work is covered. qK! RC} rsaPl nyJr.a wyr•.SJC~ 1])SUU7N111. S1 nw::i.w. :.y . iLf'1, 944.n14 ' 61M ANG W4HaSN5 51 VpUL 0AVUj hyjUj !(i121 J%. )"l ]01W 6UHNSVILLf VNWY.HUPrySVIILLMiNM1SSJ)1 Ili11i Y.P4 !y]0 &SIPAULTITLE RJSUFANCE CURPpRFT10N ORDER NO. D-7706 DATE May 14, 1981 . SPECIAL ASSESSMENT SEARCH Legal Description: c Lot 9, glock 6, Cedar Grove No. 6 County of: Dakota PropertyAddress: 3889 Serpentine Circle, Ea an Plat: 10 16705 090 06 Owner: Voehl, LeRoy b Marlene Parcel: SPECIAL ASSESSMENTS NOW PAYABLE ARE AS FOLLOWS: Beginning No. of No. Remaining Levy No. Type of Improvement Year Years Years BALANCE BALANCE NONE PENDING ASSESSMENTS ARE AS FOLLOWS: Project Current S.atus Estimated Cost NONE APPROXIMATE COMPLETION DATE FOR PENDING ASSESSMENT IS: AUTnOPIZED SION4TURE a40.SA5:12/79 . / 3 1991 BUILDI G PERMIT A P~TION CITY OF EAGAN i G SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL ~J 7 2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL 3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PIANS 1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS OF RENTAL UNITS OF FOR SALE UNITS PENALTY APPLZES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER M[TST DESIGNATE WHICH ADDRESS IS DnSIRED. NO CHAIvGES WILL BE ALLOGED ONCc BUILuING rERMIT IS ISSJED. PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMBER. ':5-r-wmyn aeu-! To Be Used For: Valuation: 4~w- Date: ? ~ Site Address ,~'2~ SGt~/WiY~(G CiRLl-t ~ OFFICE IISE ONLY Lot 21- Block 4~p I'~D FEES Occupancy R'3 Bldg. Permit q,DO Zoning Surcharge Parcel/Sub C6/,~q.~L /~r/2vve Actual Const Plan Review Allowable SAC, City Owner .JWh d- Jfi4/Y 1)(Zl5loZ1- # of stories SAC, MWCC J Length 2~- Water Conn. Address 3 /~fl ~~9' Scuc~l"(kG Lii1c.) r. Depth 121 Water Meter S.F. Total Acct. Deposit City/Zip Code ,E;4r~N S"S J,ZZ Footprint S.F. S/w Permit S/W Surcharge Phone 41~9/-OSe`/ On site sewage_ Treatment Pl. On site well Road Unit Contractor 5el_P ifWCC System _ Paric ueu. City water Trail Ded. Address PRV _ Copies ~•SO Booster Pump _ City/Zip Code SUBTOTAL APPROVALS Penalty Phone Planner Lot Change Council TOTAL ~ Arch./Engr. ~GLfC Bldg. Off. j)S 9_kJ11 Variance Address City/Zip Code Phone # C, agrees that all work shall be done in accordance with ignat re of Contractor) all applicable State of Minnesota Statutes and City of Eagan Ordinances. ~ a•e ~ ~ TY<D ~ j . r ~ . . . . . . ~ . . . . . . . . ~ . . . . . ~ (Q Zb NoT ~Cr.K R~4u~RE~D 4~~/PESS ~?iivDDrvS NOR iNT~e~C~~/!~/.dED w~NlX~c?'G1~N~tiG-S . . , Do NOT CreF47S', S!T A-TTONJ G/N/C!P C16~47~, ; EKc~'IV~' L;47F.X ~i2F354KE oN~ OvST7N4 : ,~JtLiN r, ~ . , . . . . . . . . i . . . .l. ~OJ I . . . . . , . . . ~ i . ~ . . ` i . d i . . . 'i . 'i . . ~ . . . . ~ i . . . . , , , . , . . . . . _ , . i . ~ . . . , . ! ! . . ~ , . . . i . . . ~ : i : ~ - . . ~t . ~ , ~ I , I ~ LoNti2a{c $LR~j ~ i : ~ ,SUtEEN 17 . . . . . ~ ! . . . : v~ ~ vL , . . . ~ . ~ . ~ . . , ' ! . ~ ~ . ' ' ~ ` i • ' ' i ! ' . . , . . _ , "--r . . . . . . . , ~ ~1 i I I I c nT~ ; L./ N t ~ ~ ; ~ . ~;~~.'c, 2006 RESIDENTIAL PLUMBING aeRnnir aPPUCarIoN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date I C~o ~ 1 ~ C Site Street Address t~iUV'~ aQr=~Idk tJnit # Property Owner~ 6q/-Pef ~xa Telephone #(95.) lpz/~-eLO /O Contractor ~%P.IzONI~ N(4 Teiephone #%p51) 3 105 I 0 - Address E~, MN 551 City State Zip The Applicant is: _ Owner COntractor Other Septic System _ New _ Refurbished Submii 2 sets of plans and MPC license Includes County fee $ 100,00 . . Per es=builf - $ 16.00 Aiterations to existing dwell7ng $ 50.00 _ Add plumbing fixtu2s. This fee inGudes installation of a water softener and/or water heater at the same time. !f you are installing onlv a water softaner and/or wafer heaYer, do not complete this section; mave to the nexk section and check the appliance(s) you are instailing. _Septic System Abandonment _Water Tumaround (add $130.00 if a 5/8" meter is required) Other: WaterSoftener ~WaterHeater $ 15.00 _ new replacement Lawn lrrigation _RPZ ,_P5/B _new _repair _rebuild $ 30.00 State Surcharge $ .50 Total $ ~ S -50 I hereby apply for a Residentiai Plumbing Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of Uie City of Eagan and the pfumbing codes; that I understand this is not a permit, but only an applicaGon for a permit, work is not to start without a permit and work will be in accbrdance with the approved plan in the event a plan is required to 6e reviewed and approved. ~.obe.~t ~al 12 ApplicanYs Printed Name ApplicanYs Signature JUL 2 b 2007 ~~gtl~O BY