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3205 Jurdy Ct SRESIDENT OWNER Name: Trcl c y (.v 4 i 4 Phone:G' r a- 3 8 8- 03 Address City Zip: '3 a 0 S .T L. i C A S o J CONTRACTOR e Name: 2 S S i c v. Ph, m S i n& -k f"' License 0 S 5 S S Address: P. V 60 x a 'D- City: Z_ ct e State: YHA/ Zip: -5 S d Phone: (0 S i (P I 2 C oL Contact Person: i V t_ S c )-1 i +2._. OF WORK New Replacement Repair Rebuild Modify Space Work in R.O,W. Description of work: C. o)-) )7 e C 4 A, ct ,I' -fie. PERMIT TYPE RESIDENTIAL Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures RPZ PVB) Main Lower Level) Septic System Water Turnaround New Abandonment s� r 2 i Q s l r `tom RE AL FEES: .50 imam Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 (includes $.50 State Surcharge) Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Lawn Irrigation $50.50 Add Plumbing "Water Turnaround $100.50 Septic System $90.50 Fire Repair (replace (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 0 il!Pai• of Earl 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Of\ S C ?-i r Applicant's Printed Name DEC 11 2009 Foromeause Permit Permit Fee: 5D Date Received: Staff: 2009 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: 6 Site Address: 3 R ©s C S u v Tenant: Suite 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 o 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. ° ,� �►G,�r� - WATER SERVICE PERMIT { P ERMIT NO: ;Ea g•�'o 106;; Road . gan,` MN 55122 t DATE: ,- Zohing: No. of Units- a =,I';,ex: ° Address Site Address: " ` ' . Ott Plumber: xr s + ' 't v44,3, 7 $ ° i c z Meter No.: 1 Cdnnection Charge: 0 4n, Size: Account Deposit: Reader No : Permit Fee: I agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges:' Total: Br sate Paid Date of Insp.: Insp.: SEWER SERVICE PERMIT CI O EAGAN ` ER MIT NO. 3195 Pilot Knob Road �.t Eagan, MN 55122 - DAAEE Zoning: No. of Units; - Address: -� Site Address: ' = .� Plumber:_ • - - 1 agree to com with the C ity of Eagan Connection Charge: G ' ° A ccount Deposits " --- Ordinances. •, � ' Permit Fee: - ;f Surcharge:` By r Misc. Charges: - ,, Total: .a bate of Insp.. � = I nsp.: Date Paid: t .