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3826 Willow Wayaddress: Site Plumber. Gem$ �J►8tt °,. Meter No.• s Connection Charge. 70.Ob 1 Sizeti 'Account Deposit. f `3.00 , � `x Reader No Permit Fee* 10 -00 pd 1 ogre to amply withih. •City of logon Surcharge: - 50 p[4 Ordinances. 3A1sc. Charges: 61.00 pd ; Total: By Date Paid: Date of Insp : 7d i : . . p AGAfd b fload Zai' Owner: Address: Site Addr ass.:f 3826 Will W; Plumber: 6--22-84 44297 t agree to comply with the City f Eagan Ordinances. 01 s PERMIT NO.:' PATE: No, of U1; 4 L5» Bi Briar H 4Cx1 ; Ganz Rya. 1 tonnecti Account Deposit. Permit Fee: Surcharge Misc. Charges -. By Dote of 1 I nsp.:-- Charge: 42g • QQ Ed i�.tiQ �d 5 Dote Poid: �City o[Egli 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 6755675 Fax: (651) 675.5694 FA ,t; ,D Use BLUE or BLACK Ink For Office Use Pernik*: / 7 Pernik Fee: 5 7 75 Date Received: I o /A 0/13 Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 3$rx'/ 35 � tnr/i.L6w i A� Date: / Q _ 9-/3 Site Address: 3 83. S' a 3 ii' 3 o NEA -7-w1_ tett Unit #: J Name: 44 fi C T /y1,4,..)4 GZ m £ T .x;• -)e Phone: 743 -s"93 9170 Address / City / Zip: 'S b C i4 Applicant is: Owner X Contractor '4' p 6a1:,.6E,.1 VaK.t? m -N sryz7 Tyle: Description of work: --7-"E•44 ©f=ir= Construction Cost / 3 r 70D .' 'c Multi -Family Building: (Yes X' / No _) Company: £ 1 4.7-EA/ode P14»j-r. p, Contact tAv / d.1 riei o RR i Address: 1/0 S t D ST . C;�. /%1 PL s , State: /Y/A.1 Zip: SreN 9 Phone: ''z -'6, - License #: !3 C Pi/is/ Lead Certificate #: If the project is exempt from lead certification,. please explain why: (see Page 3 for additional information) QL�/es Po.— l 97 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: CALL BEFORE YOU DIG. Can Gopher State One Cali at (651) 454.0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive lodes of underground d utilities. www.aooherstateonecall.m, 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 days of permit issuance.by a building permit issued in accordance with the Minnesota State Butldir Code must be completed within 180 x br4v/b. ilo2!ZtS Applicants Printed Name x Applicant's Signature Page 1 of 3 *City oiBap 3830 Pilot Knob Road Eagan MN 68122 Phone: (651) 675.6675 Fax; (651) 6754694 Use BLUE or BLACK Ink For Office use Pent Permit Fee: '7i1 3 Date Received: Staff MIT APPLICATION a%,..3. Date: S " J I/ Si t6 Addre6s: $x V. 3" (0 3 , ?? "3 o a`%i47-1>/42 L Q- unit #: 2013 RESIDENTIAL B Re5idenU Owner Name: e% 4' d M.A.,. 46EimEA.1 i ,A. kJ C. Phone: 761 - S"y'3— 9770 Address / City / Zip: ASO 1) C 4T/.. A✓, A) , 14 604 6g - 1/044 -ti Y /OA) Ss y/. 7 Applicant is: Owner k'Contractor Type of._;11Uorlc, Description of work: Rs.._o., >= a. k E pL d -c- S, Ai b d ,-,�-sL, a M s r,9 L• Construction Cost / 4; Y un • w Multi -Family Building: (Yes is / No _,) cot:Arad:or Company: a£ 1 Ler r ✓ 0 2 /2/4•1 ax -r- . ev a Contact DAL), t 43, 21z, S Address: hJDT L.) !o[> �T, City: /11 PL State: Plik. zip: 57)-1/4 9 Phone: 6P/ z • g 42 / - 6.2 y 3 License* 'a L 21/./1 3 1 Lead Certificate #. If the project is exempt il,c 6,.S. from lead certification, please explain why: (see Page 3 for additional information) 111,.iL2- Pest- is" 1n the last 12 months, Yes If COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEIN _BUILDING has the City of Basan Issued a permit for a similar plan based on a master plan? yes, date and address of master plan: _No Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: _ NOTE: Piens > d � •/!�•.' B eieia '%,}tin rh of ; r, the Aviki menet el es' •fC #, .a7!Ai tDO,: ',' CAU. BEFORE YOU DIG. Call Gopher Stabs One Call at (661)454.0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.000herstateonec6ll.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 le 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 Stabs Bulidl days of permit Issuance. Applicants Printed Name Z0/TO 39Vd x. Applicant's Signature Code must be completed within 180 Page 1 of 3 INICW IX3 I3g L9Z9I983T9 St':ST tTOZ/6T/Z0