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4300 Clemson Cir, Unit BRESIDENT OWNER Name: ' 13 Ec— / -- Plq ill Phone 9- -, V O ° - er9q..27 Address / City / Zip: e l 3 0 , C LE m1$cY/ Ci nt,CLE' E 04 6,44✓ 53 /...,.:R Applicant is: Owner -. Contractor TYPE OF WORK Description of work: PL C E el -A, 12 fa :. �A rt SA_ Construction Cost:' //i95/ c Multi- Family Bu ding: (Yes i< / No ) CONTRACTOR Company:Ji!"../ (2 / Ty &A /1./4&E '7>C)ie. Contact: � f VE ©l (84‘4=4 Address: .51 &®®r() E AV& N City: 4,4p 1 5 State: /2 2 N Zip: c: 8 Phone: q 5 6).7- 7 "I 5 60 License #: L-303 i Lead Certificate #: MIT" 72 7 3 -- If the project is exempt No from lead certification, please explain why: (see Page 3 for additional information) 1-E&i In the last 12 months, No If COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan issued a permit for a similar plan based on a master plan? yes, date and address of master plan: _Yes Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may classified as non - public if you provide specific reasons that would permit the City to conclude that the are trade secrets. Date: City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 x $ UC`JiA0 -H YTii Applicant's Printed Name Use BLUE or BLACK Ink For Office Use Permit #: 1. _ Permit Fee: D' • Date Received: Staff: -3a 2011 RESIDENTIAL BUILDING PERMIT APPLICATION 3 3®/01 Site Address: 9 3e6 CL-cMS &W C / RC1 -E" Unit #: f✓ 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 arr 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 plan „ Exterior work authoriz4d by a budding permit iss `d cQrdance with the Minnesota State Bui Code must be completed within 180 days of permit issuance. X Applicant's Signature Page 1 of 3 CITY OF EAGAN Permit No: Date: 3830 Pilot Knob Road Meter No: Size: P.O. Box 21199 Reader No: Date: Eagan., MN 55121 Owner: Site Address: Plumber: Conn. Chg: Zoning: Acct. Dep. No. of Units: Permit Fee: Surcharge: I agree to comply with the City of Eagan Tr. Plant Ordinan s. Meter: Misc.: By S� WATER SERVICE PE IT • CITY OF EAGAN SEWER SERVICE PERMIT 3830 Pilot Knob Road P.O. Box 215"99 PERMIT NO.• Eagan, MN 55121 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber: 1 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 ~r I For Office Use non Permit 12 ~5,()D t io EaV ~ Permit Fee: I 3830 Pilot Knob Road Eagan MN 55122 ; Date Received: Phone: (651) 675-5675 i i Fax: (651) 675-5694 1 Staff: I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date; Site Address: 0 ) )-1301 X ~'_IC►wtSO L C ~ Unit Name: ~ (~1UAl Phone: bIR Z~Z7S`~ i Resident/ I Owner Address / City / Zip: tl t'e Applicant is. Owner Contractor Type of Work Description of work: &01tiCP iw It Irv J_a Construction Cost;.... F LQ._ tidtnT-(Yes tRb - - Company: TL8 Contact: Contractor Address: q3 , Ko ' C~ r te, N City: 4 ti(-(L0 111(1✓~ 3 (a0--7q7- 75 State: Zip:- Phone: f L;LZ,-, - ea e i ica e If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) ` t 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.gopherstateonecall.ora 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 S to But i Code m st be completed within 180 days',,ofjpermit issuance. Applicant's Printed Name App i nt's Signature Page 1 of 3