No preview available
 /
     
1604 Mallard View IC ATER PERMIT' } • 1=F E it '«1�1t.Y : t TY OF EAGAN PERMrf DATE 611-4,v9- : - 3830 Pi}Knob F d. WATER PERMIT # 1051 sew PERMIT # P . 0 Box 2t k93. METER # - B. REOEI T # ,. •^. ?451 ,, . - E agan > M 55121 READER B P. RECEIPT A'fE / 13 / 9 1$ETER S ` ` ISSUE DATE, • = PRV BOOSTER P SITE ADDRESS `` `' / . _ . _ y PER QU TED , BOCK ' SE S U B c/ APPLICANT : ° e� SEWER ATER TlS ESS ° c " . , C /IMO 'r RESIDENTIAL C� , STATE % � . a ZiP r- ,3"?'. �' NEW EX 11IGf af#,.i3MBER: A O E< SS,rc; t ' 1 I. C IE TO CO t.Y� CITY-4F- — ZIP C ITY, . STATE J ......=—,.., . — " . ' - p 1 ?,� 5 - � , J r r. t - 1 ADDRESS SIGNA IRE WHEN R , STATE .,ZIP f PHONE: SE A1 WORKING YS� tPRQ. ING. FO "O A SEWER PER/ CONTACT x= r � � 6 — z r- 7 -,-,- - - - - - - - - - - - - - - - - - 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