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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 _ � III of dr 'x t" � . � . n � i _ ,mo �rdi'". 4. _ • 1� , ' , Co nt ; N Permit Foe: to, " nd 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 /Oft tiger , .. _ r 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 ,, r mount Deposit: " 1 Permit: n „ ; B Date _. i Misc. a sst n . Total: 1(rs41.t __ Date Paid: