4547 Scott Tr` City of Eagan
Date:
TYPE
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
ESIDENT
O WNER
Licensed Plumber:
Mechanical Contractor:
of
011 RESIDENTIAL BUILDING PERMIT APPLICATION
) Site Address: ` f 7ce'` 5 K
Name:
Address / City / Zip: `f rk (�
e-6441.5 -
Applicant is: Owner Contractor
Description of work:
Construction Cost:
Company:
r
For Office Use l
Permit #: G i 0 23 7
Permit Fee: $ 76 . V
Date Rerfeived: a J l J
Staff:
Unit #:
Phone:A/_7?1 I 7
#4--h , t n ..97.5 2_ 2
n L
Multi - Family Building: (Yes // No
Contact: /S,57 — /C - 2.
Address: City:
State: Zip: Phone:
License #: Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
Use BLUE or BLACK Ink
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:
Phone:
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 Ci ty'tc
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.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.
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.
Applicant's Printed Name Applicant's Signature
Page 1 of 3
WAS
illtOilet ..
' 1 PERMIT N.P _ �
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fi io i w r rMh► �rMlr 11110 r of ily.. . siJrci a r s e: 150 pc'.
IOMpIw Misc.' Oiarg*s: $ i :.. „
Total:
gy r ®% .r. Date Paid: .
00. of J, =.711i '. i p.•
aTY .O EAAAN _ . - , SEWER SERVO PERMIT
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3 iia , irIN5:it22' PERMIT N4- , -
i DATE r 2
Zoning: - r r
' Owner
Mo. of Units: .,
Address: ~-• -.--
' Add ress: h r
1 �' ' Z 7 w f t o .. ''
phoptoor: ^IM1 P"1
. 1 ogee. to empty with the City '°E n Connection CiQrpt: 1 2 5 r ,,
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mount Deposit: " 1
Permit: n „ ;
B
Date _. i Misc. a sst
n . Total:
1(rs41.t __ Date Paid: