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1761 Bluebill Cir îý íñ ÿþþýüñüû úýýþþíòî ðüöö ßßð ÿþ ÿþýüûú öàøäøþüûú øüûú öàø÷öàêú ô øúîþ äþäïáïãþú û Ü ÿóþ øù ôúøìôòòôøóþøôø ýøôç å øööú åøåø ô þ úçä åøå ú åø ç ä øýôæø øøóþøýû öå ôûòôç ùèáíèççï ÷ú ÿþøò ø þ èáíèççð þ á ç öðô ùó úú ãÿäøþ øý ø ÷ í ûô ø ßþýäø þìñ÷á ñ÷ðð ëéðï òøýû öò ò ìø ò úú ò òåøô øø øôúûöò úú ýÿ åñ ÿ þ äûå ãø ç úú à þûÿ þø CITY OF EAGAN WATER SERVICE PERMIT 3795, Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: —_— Zoning: _ _ —_— —_ No. of Units: _ Owner: Address: Site Address: Plumber: — -- - — — Meter No.: _ — Connection Charge: Size: Account Deposit: Reader No.: _ Permit Fee: agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: _ Total: By — Date Paid: Dote of Insp.: 3- '7 _ Insp.: CITY OF EAGAN SEWER SERVICE PERMIT 3795. Pilot Knob Road PERMIT NO.: Ecgan, MN 55122 DATE: — — Zoning: No. of Units: Owner: — Address: _ Site Address: -- — Plumber: — agree to comply with the City of Eagan Connection Charge: _ Ordinances. Account Deposit: Permit Fee: Surcharge: - - -- g __ _____ — Misc. Charges: Date of I nsp.: — Total: Insp.• — -. _ Date Paid: -- O to `1 t t-1(01 61 u.4 G r Use BLUE or BLACK Ink For Office Use 21 j i Permit t City of Eap I Permit Fee: !,A • -157 3830 Pilot Knob Road 1 4 1 Gate Received: IQ Z~ 1 Eagan MN 55122 I t Phone: (651) 675-5675 1 Fax: (651) 675-5694 Staff. I t•----------------- I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION I-i3 Site Address: 17591~t;1 17G3 I~asS 171s7 'i~c.9 ~t•rcb~~Uni Ia Date: a Name: Phone: Resident/ Owner Address / City J Zip: s Applicant is: Owner Contractor ' Description of work: G> ` c ^ i Type of Work ~ y Construction Cost: -t , ao d Multi-Family Building: (Yes AJ No ) Company: " 140A_i Contact J~ I Address: (i ~''7, t)t.1C C*,(- JA- Z>. City: r Art a Contractor I q State; (Y1 1'J Zip: Phone: 2?0-0 l 4 License ~j~ Lg ~J 5 Lead Certificate /1✓ f3T~~cro'7 - / If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) Le_J V 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: W 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 L....e._..__ conclude that Le 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 I hereby acknowledge that this information is complete and accurate; that the work wil I he 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,pennit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. -A- L X ! Jelru t-`~3-C r'.jc C r x Applicant's Printed Name Applicant's Signature Page 1 of 3