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CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P.O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Addess:
Plumber:
Meter No Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
I agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By c '" Date Paid:
Date of Insp.: Y — ? 7 Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P.O. Box 21199 PERMIT NO.:
Eagan, MN 35121 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
I agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
- - - - - - - - - - - - - - - - -
For Office Use
. 7irr Permit
r City o aPermit Fee:
3830 Pilot Knob Road I i3 I
Eagan' MN 55122 I Date Received: I
Phone;: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: (J`E~ Site Address: 1~r? Iu c3 4 ~60V L f~ Unit
F !Name: CJ 1 S ~ P ! V\8 /lt!#~ lr&L f f e 7 Phone:6~l ~ 7T L Z~~
i Resident/ rrOwner Address/ City/ Zip: ntf~
Applicant is: Owner Contractor 24 Type of Work Description of work: -
Construction Cost: d- >.G 0
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)V el S
Company: ~rL8 Res .r4 tw_L ~h 4- • Contact: cue.. ~ V L
A'
~i;34= kaa. nq -Ct:r c N City: L
Contractor Address:
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j State: ~✓1 zip.. C:)Phone:' 62
-7- X
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. 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.gooherstateonecall.orrc
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(yQ1~D x
Ap'plicant's' Printed Name Applicant's Signature
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