4666 Ridge Cliffe DrCITY O EAGAN
3741ot .Knob : Road
agan, MN 55122 -
Zoning: ?;
Owner 0 ` .
Address -
Site Address 1' 6 t Ri
Plumber- C : •}
Meter No Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee: •-
1 agree to comply with the City: of Eagan Surcharge'
WATER SERVICE PERMIT
PERMIT NO.:
DATE -
No of Units- I 4—p
Ordinances.
CITY +F EAGAN
3795 Pilot Knob Road
Eagan, MN 55i22'
Zoning:
Owner:
Misc. Charges: .§•..3f. .0 e
Total:
Date Paid:
3 Insp.
SEWER SERVICE PERMIT
PERMIT NO
DATE:
No. of Units:
Address -
Site Address:
Plumber:
1 agree to comply with the City of Eagan
Ordinances. -
Connection Charge:
Account Deposit:
Permit Fee:
Surcharge:;
By Misc. Charges:
Date of InsTotal
Insp.' - Date Paid:
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City of Eatali
3830, Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
12-T73J
Permit Fee: )v
r I
Date Received:
Staff:
2014 RESIDENTIAL BUILDING /PERMIT APPLICATION
Date: Site Address: Ili 1 — "/ j 7P A 4c- I/ unit #:
Resident/
Owner
Name: L1) ,42, ' /`l L !; 14-'4 her liertsPhone:
Address / City / Zip: t771' /�
Applicant is: Owner ✓L Contractor
Description of work: f e c'i f
Construction Cost: f 6, d OP Multi -Family Building: (Yes .X. / No )
Company: A%r-ui t", 5 %~ G o h r r/s+6,122 S' ContacC tr' i G flay
Address:6 6 2 Z•41/7 X-/- 4,)144- 4-4-3ITZ Al,City: y k 6:ft0
State: /2 -1/1, -Zip: 5`' " 3 ` 1 Phone: v �' D Email , J r nrei) f7, )jP W65 OO 4e,
License # ' I a l 7 3 Lead Certificate #: N =, r--;/ / / / a 3 —1
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes, date and add
Licensed Plumber:
Mechanical Contractor:
f master plan:
Phone:
ng docu
is .that you submit are con.
on :public if you provide s
onclude that they are trade
'derecf to be public infor,
�cfic parsons that wouli
CALL BEFORE YOU DIG. Call Gopher State One Cali at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gooherstateonecall.orq
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 l 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 wilt be in
accordance with the approved ptan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building penult issuedin accordance with the Minnesota State : 'tding Code must be
days of permit issuance.
x ieH
Applicant's Printed Name