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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: Z -41 -7 -At f t /‘if 0 3 \Ai i '4-... .._ 1 ....-- ...: ,...-, 7 •••••---- ----".. ) ;..... i 1/40121V10 eViOrr").9q: `?"4" nti401, ,,d„? 5 if-1.--,--7-,7A->2...c e ----- .-....,4_,I, JL- L� - s tr-V ; e 5ei9eizm:uv) -erD gq,e75 _ :1-c- dK5.1,,, • t) \ --17y 1 z - - I 1kt , ,e54-1 I/01 il‘ to- 1, -0 -4 -en )44441,:ie / 57-4,12-i /Cr 6•C- 1 1,;-' 13 •-- ...., Lew-I/L(6(0G t-tcpby 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