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4673 Stavern Pt -~:eB~1.33~3~`~ ~ t5o5~ 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