4473 Scott Tr WATER ��: PERMIT
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rb Na "CQr►nectiori Eytat�e: 33 . 00 pd
" Account Deposit:
coder No.: Perini# Fee: 10.00 pd
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i OWNS Mier. Charges: 60.00 pd meter
Total:
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Date of i f •
CITY- O& EAGAN ` EV
____...ER SERVICE PERMIT
3795.. Pilot Knob Rood 1 PERMIT NO.. 4796
Eagan MN 55122 \C N∎ DATE: CZ ‘ , "% , 6/26/E1
Zoning: RT TT No. of Units: zi duplex
Owner: 7,A chin j ntr_an S .
Address: ;
Site Address: x,471 Srn T T,3 R1 C dar Cliff II
Plumber: St Pau. Ilti ties ' \},
6/3/61 24i94 101).0 7 pd
I agree to comply with the City Eagan n nection Charge:
Ordinances. � � � • v2� _till pd
Account Deposit
Permit\ Fee: 1 10.00 pd
Surcharge: .50 pd
By I'. Misc. Charges: z
Date , ( . 1. :e��� �,
r P Tot al. ,
Insp.• - _.. . Date Paid:
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Use BLUE or BLACK Ink
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Permit
City of Eap I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: 10 1
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION :tfq/4
Date: QD 11 3 Site Address: q'1 / J Jww ` vz I ,tA) t nit # L4tf T;,Ie-
Name: 2 DT f U)1I►K 3 Phone: S`Z ?&(,J22ff
Resident/ ii
Owner Address / City / Zip: 73 vu4 1 /~IAJ (2 Z
Applicant is: Owner Contractor
Type of Work Description of work: Pe f o a~-- S` d 1~ ~C Construction Cost: Multi-Family Building: (Yes 2t-lTzb"~
_)4 Company: ///(1 11'W 6T*YUG&$uz .4-VK'Contact:
Contractor Address: ~j lb bM__V ~f• fV~ City: _S!` State: 1V N Zip: ~I 3L Phone: -76 ,7 q - J
i License 7 ~(SJg Lead Certificate
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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
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:
i..
E NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
i 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. www.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.
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Ap icant Printed Name Ap sSignature
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