4534 Mallard Tr SCity of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4534 Mallard Tr S
Lot: 20 Block: 3 Addition: Thomas Lake Woods
PID:10- 76100 - 200 -03
Use:
Description:
Sub Type: e - Underground Sprinklers
Work Type: Backflow Preventer
Description: New
Meter Size Meter Type Manufacturer
Comments:
Fee Summary:
Contractor:
Bruckmueller Plumbing & Heating
3992 Pennsylvania Ave
Eagan MN 55123
(651) 686 -6696
Eric Bruckmueller
3992 Pennsylvania Avenue
Eagan, MN 55123
Total:
PERMIT
City of Eaan
PL - Permit Fee (Res Modifications)
Surcharge -Fixed
Applicant/Permitee: Signature
- Applicant -
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Serial Number Remote Number
Owner:
Charlene N Bolt
4534 Mallard Tr S
Eagan MN 55122
$30.00 0801.4087
$0.50 9001.2195
$30.50
Plumbing
EA078078
06/04/2007
ePermit
Line Size
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
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OF .E flOb Rd. # ' ' PE _ , # 15.14 .
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Eagan, MN 55121 #, ***., .P.1 ,Et, T ►T' 93
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SITE AD 1 4534 South allard T � _ TEO
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AP�ALtCANT: Th a t eve1 Qp t , Lt cl
ADDRESS; tit i ;tOa. 6 ' E �� �M�,. X 9iD�tA
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PHONE 4X 242 ' X rJ.E ' t
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4 w o STATES A'r or bake- ZIP
PHS:/ / ''' i A° * '''' : -*"'-' FOR STEStql MIER PERMITS , ,,
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I For Office Use
I I
Permit#:! Z11
City of Ea~a~ -
I Permit Fee:
3830 Pilot Knob Road l 1
Eagan MN 55122 Date Received:
-9 1
Phone: (651) 675-5675
1
Fax: (651) 675-5694 j Staff:
I 1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Ad/dress: l Unit
Name: '7 3 At 3 q, rr, IWPhone:
Resident/
Owner Address / City / Zip:
r1iL
Applicant is: Owner Contractor
Type of Work Description of work: roo
Construction Cost: Multi-Family Building: (Yes No )
Zvi J
Company: / 11 ~Contact: ~a ~~d
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Contractor Address: v~ 4` ity: Lc~j~Lf
State: Zip: 3 Phone: al / 6 3 oe
License SC 6 J 6 3'~;- 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: i
Sewer & Water Contractor:___ Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of M
1 the information may be classified as non-public if you provide specific reasons that would permit the City to I
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 di to receive locates of underground utilities.
~ 9 wvsN.gopherstateonecall.org
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 Code must be completed within 180
days of permit issuance.
x nce.
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Applicant's Printed Name Applicant's Signature
Page 1 of 3
1
For Office Use
N : ''. 1. )-?Lt X
Permit#:
4.•�sie i E AG A N
4�
Permit Fee:
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD:(651)454-8535 I FAX: (651)675-5694 Staff:
buildindinspectionse.citvofeagan.com L
2018 RESIDENTIAL PLUMBING PERMIT APPLICATION
D 11 A A(ZT 'z_Ls
Date: :,.1 'Th—
Site Address: � � �
Tenant: Suite#:
Resident/Owner Name:1 �, Phone:
Y
I Address/City/Zip: 41'."n l S iN (2)0 4� 1`-
i.
Name: � t /v S 6 '~.)i LP7 License#: 0 1"
Address: ) 1 C; t 1 C- City: 1-012-6-(:?. f' l�- 'Contractor
`- 6 '781- 1
State: ! 1 Zip: Phone:
��
ii _
. Contact: 1 F--L l' L"�~� Email: 1 L-{. �j 6 I1- -1 C L:, 3 3 Pc\i") I L` 'C'C fir'\
1
New Replacement Repair Rebuild Modify Space Work in R.O.W.
Type of Work }
s c pt on of work pL. C (� F2�� t tj— G�-i 12-6,53t—
,
Des ri i
RESIDENTIAL
j
1 Water Heater
Water Softener
s Lawn Irrigation( RPZ/ PVB)
Permit Type
Add PlumbingFixtures Main/ Lower Level)
Septic System (
New j Water Turnaround
Abandonment I
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation(includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Turnaround*(includes State Surcharge)
*Water Turnaround(add$280.00 if a 3/4"meter is required)
$115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES $
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
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeagan.com/subscribe.
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. ili;,,
ft,1LHA --- /- �-- --Yk 1, _. (Ln
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections; Under Ground Rough-In Air Test Gas Test Final
Meter Related Items: Meter Size Radio Read Manometer Staff: