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PLUMBING (RESIDENTIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
~ ~-~j ~ Telephone # 651-675-5675 FAX # 651-675-5674 ~ ~ ~ . ~
Please complete for: Single Family Dwellings
Townhomes and Condos when permits are requ'ved for each unit
Date ~ / ~ / ~
Site Address lS~ I~ c~ 1 G~ J[2X YL ~[J I?L{~ Unit #
Property Owner V~ VYl l.i~~' LQ. ~~'e-~'~ Telephone ) 7S2"72~I~
Contrac[or
adaress 6d5 -12th AVe SO. C~ty
opkins, MN 55343
State Zip Telephone# ~j<~ Q~~~~
The Applicant is _ Owner ~Contractor _ Other
a
Septic System New _ Refurbished Submit 2 sets of plans and MPC license ~S~ $ 100.00
Includes County fee. Additional consultant fees may apply. ~
Alterations To Existing Dwelling Unit, Including $ 50.00
Adding fixtures to lower levels or room additions, excluding water softener and water heater
~
_ Abandonment of septic system
_ Water turnaround 5/S" meter if needed -$121.00)
Other:
_ RPZ _ new installation _ repair _ rebuild $ 30.D0
_ Lawn irrigation system
_ Water softener ~ Water heater O~~~2 ~ U~ l $ 15.00
~ replacement _ additional ~ Z003 I
N~V
$ .50
State Surcharge gy
Total $ J~L--
I hereby apply for a Residenual Plumbing Permit and aclrnowledge that the information is complete and accurate; that the work will
be in conformance with the ord'mances and codes of the City of Eagan and with the Plumbing Codes; that I understand this is not a
permit, but only an application for a permit, and work is not [o start without a pemut; tnat the work will be in accordance with the
approved plan in the case of work wluch requires a review and appxoval of plans.
~Nilf\ ~V1`~ ~ f c/\
Appl
cant's Printed Name A plicanYs Signature
4VAGAN
Mgee, MN 55122
Zoning-
Owner.' ' " r r:.
Address:
Site Address: ` 3ta;;ern_t. L2
Plumber: r
>cclifac ITT
I sine to amply with Ole pry .f Eagle
Ordisenses.
By _
Date of -firs r .''
_ i
Insp • ��._ f
3. CO
Connection Charge: L, ' -
Account Deposit.
Permit Fee•
Surcharge:
Mix. Charges:
Total.
Date Paid:
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
1113—)
Permit #:
Permit Fee:
Date Received:
Staff:
1,9e)
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address:'477,41617 SYQ.Leigo Pi -
G):
/lfl tU #:
Phone:
Address / City / Zip:
Applicant is: Owner VContractor
Description of work: 1"71.1) /e —st 1/
Construction Cost: 2--1:%l ®®L7 Multi -Family Building: (Yes° / No )
Contact: dyz° /✓"-•
City: eta, dh-
670- --kt 6 -Wei?
Company: /2/21.41/'e. /
Address: 1fCf–
State: _L Zip: SeC 'j 37 Phone:
License #: 3 lT O 6
407
Lead Certificate #:
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. Pr
the information may be classified as non-public if you providepe igc re sc n ti i u C p mit tl '
conclude that the .` rutrade s
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
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 1 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.
ItA n// 5Oke ire
i /
Ap icant's Printed Name
cant's ignature
Page 1 of 3
111111'
City of EIIQaII
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: 3
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
"/c 4/6"73 i/4 .,7 --4914
/ Site Address: 2 L, /Z,SO HO/211W p -r- Unit #:
Resident/
Owner
Name: 8016 41 6 L f /::::re— .. i Phone:
Address / City / Zip: 54 S c2 i1
n. )�J//�
Applicant is is: Owner ontractor
of Work
Description of work: "i/ej -v' iel rl e /✓Z'7 / 5/ 4.--y
Construction Cost: Fe/1"/ .4'6'4' Multi -Family Building: (Yes No )
Contractor
P Y �"'"'!,_
Company: j ,�q
Contact: 4('e,4*.e. '
Address: (3 7O cX e r %tF° ! City: BI} fly/✓4
State: /*/ Zip: 57337 Phone: 4:0/2- — 8/L A- 66
License #: .2 16,3 (d 647 Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes _No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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.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 Building C must be completed within 180
days of rmit issuance.
4 115-e peijc't- x
Appt's Si Lure
Applicant's Printed Name
Page 1 of 3