3545 Blue Jay Way Unit 207RESIDENT / OWNER
Name: P"G v /4 A As 0 Phone: 6 S/ k 0 /Sy
Address / City / Zip: S C f .�
CONTRACTOR
Name: F u rr 6 , ' , . . a /Id (�`c k If � License #: (3 9 7/ — PM
Address: 3 3 0 (✓✓ (1. (1 �.. City: (, o id-eA V .4 lt.R
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State: MA/ Zip: y l 2 Phone: ? 4 3 ‘7 o ,� 3 S
Contact 5 r>G 0 , ,'n n Email:
TYPE OF WORK
New _Replacement Repair Rebuild Modify Space Work in R.O.W.
_ _ _ _
Description of work: 4c c _ VO / r Ws( 7`-/ 4 12.4r e r
PERMIT TYPE
RESIDENTIAL
Water Softener
K
Water Heater
Add Plumbing Fixtures L. Main / ` Lower Level)
Lawn Irrigation (_ RPZ / PVB)
_
Water Turnaround
Septic System
New
_
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Wat Heate ater 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)
bumed out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $
Gity of Eats'
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2010 RESIDENTIAL PLUMBING PERMIT APPLICATION
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Date: / d/ 3-�
/ / 7/ 0 Site Address: - YS Say N j - if P'0 7
Suite #:
Tenant: Pa (-it 4 4$ L C
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Applicant's Printed Name
x
Applicant's Signature
Use BLUE or BLACK Ink
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Permit #:
Permit Fee:
Date Received:
Staff: I
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CALL BEFORE YOU DIG. Cali Gopher State One Cali at (651)454 -0002 for protection against underground utility damage.
CaII 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 penult, but only an application for a permit, and work is not to start without a penult; that the work wIH be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
FOR OFFICE USE
Required Inspe ons•
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A
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA154965
Date Issued:04/19/2019
Permit Category:ePermit
Site Address: 3545 Blue Jay Way 207
Lot:259 Block: 04 Addition: Lexington Place 2nd
PID:10-45051-04-259
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Pauline S Afuso
3545 Blue Jay Way 207
Eagan MN 55123
(651) 202-6788
Homeworks Services Co Dba Homeworks Plumbing Htg
1230 Eagan Industrial Rd, Suite 117
Eagan MN 55121
(612) 400-9020
Applicant/Permitee: Signature Issued By: Signature