4153 Ruby LaneRESIDENT /OWNER
Name: HQJ€.trt RA p k Phone: Lo5I`R
Address / City / Zip: 1 -11S3 R t 1 i 1-•a v e I CL rn n
CONTRACTOR
Name: POI' v-vx C\413 f ( License* rA 1Cl. P
1
, 2�rt t2 P ve. City: F r I I `1'D k
Far Address: �t ) 63 4
L
t
re
State: Zip: 555 L Phone: 62,5 1 ` q (03° - 7 sal
_
Contact: J: ✓"1 Email:
TYPE OF WORK
New "j Replacement Repair Rebuild Modify Space _ Work in R.O.W.
_ _ _
Description of work:
PERMIT TYPE
RESIDENTIAL
Water Softener
A Water Heater
Add Plumbing Fixtures ( Main / _ Lower Level)
Lawn Irrigation ( RPZ / PVB)
_
Water Turnaround
Septic System
New
_
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation
$55.00 Add Plumbing
*Water Turnaround
$105.00 Septic System
$95.00 Fire Repair (replace
(includes $5.00 State Surcharge)
Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
(add $166.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $ 5 5
City o(EaQali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
xc et h,.■evl
JUL OS RECD
Applicants Printed Name Applicant's Signature
Permit #:
Permit Fee:
2010 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: e -1b Site Address: `'1 tS? i t {- ..GL P.
Tenant:
Date Received:
Staff:
Use BLUE or BLACK Ink
4 l
Suite #:
J
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.
FOR OFFICE USE
Required l
Under. Ground''
Test Fi.
Use BLUE or BLACK Ink
Y I For Office Use
Permit
City of Ea~a~
I Permit Fee: 04Y1 i
3830 Pilot Knob Road I
Eagan MIN 55122 I ?
Phone: (651) 675-5675 i Date Received:
Fax: (651) 675-5694 j Staff: j
1-----------------I 6
2013 COMMERCIAL BUILDING PERMIT APPLICATION 4 whl ~
Date: O~ 1771 (1 Site Address: 1 ^ i I y~~~~y~ssf y~ s~ 124 L VZ
Tenant Name: Q~ ~~th (,otfts ~.i►~~aS ~ ~ar~cn kom%(Tenant is: New / > Existing) Suite
Former Tenant:
Name: r.N Got~hohs V M0.6 ok,%A a1aC~s w ~cS Phone: S5a- 4 3 a' 817 9
i Property Owner Address/ City /Zip: _P.d D&X S f103e.ho\)V% ~ M u 55n (oe
Applicant is: Owner Contractor
Description of work 1 Graf" d ~F GK nor 5, Ct'Oh%(-
Type of Work
Construction Cost: 3 1;t s 3 7
Name: O ~ LOVX 5 ~ ("JA i o License l ) 1 { oZ
Address: lle `p~ fe V `ojv\a{ 1C- a%/L City: 1C)S<- MOJVX
Contractor
State: Mk Zip: '75_0(69 Phone:" GJr I - 2 ` 9 605"
Contact: L&J Email: LL`Jt
Name: Registration
Address: City:
Arch itect/Engmeer
State: Zip: Phone:
Contact Person: Email:
Licensed plumber installing new sewer/water service: Phone
n.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.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.
x L,,~ . , g-o v x_-
Applicant's Printed N e Applicant's Signature
Page 1 of 3