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1606 Mallard View ,. e 'DER 1 a { OFFICE USE ONL crrY b ` P E R #A#T ° - 6/14189 ` Fib Rd. W ATER 1 J SEWE # 1 ,, ft „ 3430 '.0. Box 21199 l T R P n . S P RR # C 24 1 -, ,- , i1�165,1$1 - , Re At t o t # B P-41EIZEIPt DATE (t 3 ifiq - MEtER SIIE :. R PU ° - (:�.TE� tar '1 B A !� ESS r r � PER,MT E LC CI+ �/S iB ° t - ' d... SEWER 1 WATER TA _ 4 - � RED :- E .: ZIP -" 4 NEW __ EXISTING' ,y PLUMBER - -. . :' z " ;;."1 �.; ADDRESS : 4 9 ! �,` - .t'- I 4 TGCQ .1 ,, CI Y AF' �PHONIE: f j • ,, .. ' , _,;,_'--. , ' f , -,,,- .,.: , ..„.. / . �E Y A ADO RE Y N �^' - T u/�t shrltaTCOIEWtmilitTei ; . ' CITY, STATE :'ZIP { 6 ,r 'ALLOW TWO , a , - DAY'S' FOR i t . FOR � i1 paivOth ethwrAqT PER c r RpePT. 4 , / j?-, - - - - - - - - - - - - - - - - - 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