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4654 Ridge Cliffe Dr CITY 1) EAGAN WATER SERVICE PERMIT 3795 Road PERMIT 'NO.: 31.9 Eacn, MN 55122 : DATE: 7'z` Zoning: ---- i2." .t lei g• No. of Units: Owner: 0 licr.e Address: Site Address: 4C5 . gC C31% 1,3 ale u i Plumber: r rE • .' Trot ° Meter No.: Connection Charge: 27 °b (1` Size: Account Deposit: Reader No.: Permit Fee: 1(). ` I y agree'to comply with the City of Eagan Surcharge: .50 d Ordinances. , Misc. Charges: (".0.()Cl meter r I Total: --/' ® Date Paid: • ■o a of Insp.: . , — � Insp.• f , SEWER SERVICE PERMIT CITY 02 EAGAN PERMIT NO.: 37951Pilot Knob Road DATE: Eagan, MN 55122 No. of Units: Zoning: Owner: Address: r Site Address: Plumber: I agree to comply with : the City of Eagan Connection Charge } Ordinances. ? Account Deposit: � Permit Fee: Surcharge: Misc. Charges: BY ,„ °,, Total: Date of Insp.: _ Date Fold: � � ; � �� �� t v , l U���j ��/S�, �(� � Use BLt�E or BLACK Ir�k � �----------------.. E For Office Use � ; � ��-� �73� G�� �� L� �� � � Permif#_ _ 1 � � � 1 JV �� 1 �� � Pertnit Fee: � --� � 3830 Pilot Knob Road ` Eagan MN 55122 j Date Received: � Phone:{651)675-5675 I i Fax;(651)675-5694 1 Staff: I I F � . . . . . . . . � . . . � . t�..�.���.... - ��������.�l� 2014 RESIDENTIAL BUILDlNG PERMIT APPLfCAT1CiN . �a�� �,.!"'��"`J c f Site Address• �1�1 t ��� �� �r. I � � /._�v'✓ �li'� ����� Y��i���� . . . Name: �L7�n��' G'r�f'7`j � �tv��l�rt�- � P�e: Res[dentl £�Wt1�T Address I Ci#y/Zip._ ���`✓�^' /�'�i'� � Applicant is: Owner � Contractor �.-.. Type c�f;Work Descciption of wor�k: �Grr�r �(�� �{ �c�G -rrQ°r� Constnaction Cost:��i��p � Multi-FamiEy Buiiding:(Yes�/No� � /� ..�' ,/ ,��� '' ( Company:l VUYZ��5� C_�7 v1��r��7�t7r'S Contact: �,��1 /������' , C+�ntra�tor � ,4ddress:�'�f�2 Z�r�C..f���- L,�-�x /� city:���'�C' (�,s�v�'�-- � . � State:�Zip: f5�3� J Phone:����'��Email:��f»r� �3rrLJ�S"T�Gdyl`�✓���t�r� — License#: �� ��� � 7� '��c--C'r�r..-� i.eaa cerc+�c.ate#:rV�.�r..-r-`-���l v 3 —i If the pro}ect is exempt from Iead certification,please explain why: {see Page 3 far additiona{infiormatian} COMPLETE Tti1S AREA ONtY tF CONSTRUCTING`A NEW BUILDtNG In the tast 12 mont� the City cf Eagan�ss�d a perrnit€or a similar ptan based or�a master ptan7 � Yes No If yes,date and add f master ptan: Licensed Plumber: Phone: Mechanicai Contractor: Sewer�Water Con r, Phone: tVt?I�, and s�rppc�r�i�z�tl�r+c�men#s fhat you sabmit are cz�»�id.w�d to be pc�btie irit'r�rrrl�r�ic�n Pa�rt+fot�s:of e�►f��r»a��n rr�a�y he�/assi#`�eaf�s r►on pvblic rt'yoe�provfd�s�i��c nsasons�wc�utd°�err»it�"#�e��t�` cartcfuote#h,�tf�e :ar�e tra�I�s�refs CALL BEEORE YOU DI+G. Ca11 Gopher S�te One CaB at{B51)454-0002 fQr protedion against undergrou�i utdity damage_ Cai!48 hours beiors you in#end to dig to receive locates of underground utilities. ww�nr:QOpherstateonecali�ora i hereby acknowiedgs that this infoimation is r�mple#e and accurate;that the wrork wil[t�in c�nformance with U�e ordinar�ces arid c�des of the Gity of Eagan;that l ur�dehstarad this is not a pentiif,but 8nly an application for a perm+t, and wo�1c is not to start without a pennit;ihat the wa�ic witi be in : accordane�with the appraved ptan ir�the ease af work which rsquires a reviewr and approvat of ptans: fxterior work authorized by a building permit issued in accordance w�th the Min�esata State iFding Code m�t be compieted within 180 days af parnrit issuancs. ,�J C .� � . e .. . ..�,. X L/ J''�'l ,G X ApplicanY's Pnnted Name ' ent's 5ignature ; Page!of 3 �l� l� , ��(1'��1 ��i S t}, �(a `j Use BLUE ar$l.ACK lok y �-----=----------- � For Office Use � ' j Permit#: �2'� ��� ��� ���� �� � � i ' _ �� .. i � � Perm�t Fee. �� 3830 Piiot Knob Road � - � Eagan MN 55122 i Date Rec�ived: � Phone:{651 j 675-5675 1 ! Fax:(651)&75-5694 i Staff� 1 t t . . � . .. . . . . . . . .t.�����...... - ...�����'��1 . 2014 REStD�NTtAL BUiLD1NG PERMIT APPLtCATIQN ! t ` rj�y L.r-/� ,p v <�!�i Date: V'"'I�'"j� Srte Address: `'�[� l � � �� 7 -! /�' ��j L ��/ ! Unit#: Name: �C��I'1��t' �'-�'Tt �.- /t�tv��c�rt�- � Phone: ' � i�side�ti � � � � � � � � � � �.C��AtCf�r �� Aadress 1 cit;+/�ip- � ��1�'�'`�-�" � �jli � � APplicant is: Owmer � Contractor ` �� � � � � Typ�of Work DescriptiQn of work: � c'?t� � � �°� ' Construr�ion Cost: ���l�0 � Multi-Fami{y Buiiding: (Yes � !No ) Com an tJYZ.r� r' '' / '��� �r�a }'�G��1��! p y:�/�5 C c�vJ�s�r�-G.�O 5 Contact: � C0�1#t1�i?#' Address:��[?c"'1 ��'l��y✓�°��?�*�- L,y��t /� City:���'�[" �l�G�l-��.._ _ � r State_�Zip: ���3�► Phane:����'��Email:t�►»r��Jt3r'W��'T��.�yl`Tr�✓���ear� tac�nse#:�� l�`� � 73 -r,�U_�=f., L.ead c�rtifica�#:�4.�a�.r..r r=���lt�� °-� if the pro}ect is exempt feom lead certification,please explain wtty: (see Page 3 for additionat infotrrration) CQMPLETE TtitS AREA ONLY IF CONSTRUCTING A NEW BUI�DING In the last 12 m , the City of Eagan iss�d a pertrrit for a simifar ptan based orr a master ptan? _Yes _,No If yes,date and add f master plan: Licensed Plam�r: Phone: Mechanicaf Cor�tractor: �.. Sewer 8�Vltater Con r: Phone: 11f0I�`. ;a��t svpF�rr�iFrit�;tlacu�en��tat you��hmi�'ar�,consid�red`#t�b�.pubtic irt�rm�fiv» P��#o��of ; rr��i�ativn►na�X�e�c�ass'�ed as nar►petbt�c if�o��srvvfde s�i�f1�reas�rrt��w�utd�ermtt�'+�'i#y tc� t cc�i►clu�t�.#t�t,t�e ar+e b�d��ri�ts " - ea��e�FORE vou���. Cail Gopher State One Call at(651)454-0402 for protec�ion against unde�ground�ity damage. Ca1148 hours before you intend to dig to receive tocates of urtderground utifities. www.aopherstateanecaltosa i hereby acknowledge#ha#this ir�focmation is c�nplete and aixurate;that the wrork wili be in�rrformance with the ord+narn�s and codes-af the Gity of Eagan;that I understand fhis is not a permit, but a�ly an application for a permit,a+�d wock is not to start without a pennit;t#�at the work wili be in . acxordanc;e with Ute approvecf ptar�in the case af wortc which requires a review and approvat of plarss. Exterior wark autharized by a building permit lssued ln accardance with tF�AAinnesota StaGe iiding Code m�t be comp�withln 180 days af psm�it issuanca. �, X �� 1�/'��-��� ,��' X ' ApplicanYs Print�ed hiame ' nYs Signature Page 1 of 3