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1602 Mallard View SEWER & WATER PER T OFFICE USE ONLY , �. OF E CN ',,t > - ` ' 3830 Riot Knob Rd. PERMIT DATE 6/14/ 89 P.O. Box 21199 WATER PERMIT # 1 f51 A SEWER PERMIT # Eagan, MN 55121 METER # S.P RECEIPT # C 1 READER # B.P. RECEIPT DATE 6 / `1 31 Ow METER SIZE 'ISSUE DATE Xx PRV — BOOSTER PUI0 S A RESS /Z `,/ 2i r'.t, PERMIT REQUESTE ' LO LOCK.. ` _SECISUB, ,+ f APPANT: !/ / ..544 `' t `.t' SEWE_ R ,r,, TAPS ADDRESS: Oa OL,174 c r+- co- IND V RE 1DEN' 0.1. COY, STATE ,r • ; _ ZIP J '/.?. yc a.. 2 -51 2 PHONE: � ' . NEW � EXISTING PLUMBER: .■ e --, . :} ' ADDRESS: .' :� i � '1 AGREE TO COMPLY WRH CITY OF` CITY, STATE 1 ZIP 3, 4y ' GAN �. PHONE: 3 ^1f Y, l O �� ,. OWNER: ADDRESS: TURE WHEN METER ISSUED CITY, STATE : - ZIP ' * t ; PHONE: ' ,PLEASE ALLOW TWO RKING DAYS FOR ° ; OCESSINC,L FOR �1 SEWER PERRETS, -CCONTACT ENGINEERING > EPT. �s vl / e / ,, Q '0'. - y '' j '" i . - - - - - - - - - - - - - - - - - I For Office Use I I Permit City + 4 L~. QV ~ r1 d 1 1 of EaI I Permit Fee: 1 3830 Pilot Knob Road I Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 1 Staff: _ 1 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: Phone: TTT_ Resident/ Owner Address / City / Zip: I1~ Z1'~'Li ,~~f Applicant is: Owner Contractor Type of Work Description of work: /'O0 , r Construction Cost: 3(/ ©00 CIO _ Multi-Family Building: (Yes ~ No ) Company: Contact: a~'f Contractor Address: 06 %Al J~ 6A ity: Lc~'/sVLr State: p Zip: G7S 33 ) Phone: 630 License SG 63 / Lead Certificate r1fthe 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: i I 1 Licensed Plumber: Phone: I Mechanical Contractor: Phone: 1 Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions ofp 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. WNW.gopherstateonecall org 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~t> //`d c k0th Applicant's Printed Name Applicant's Signature Page 1 of 3