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4553 Scott Tr :. �,� ►►�, *Alin SERVICE 'I T I No. of I)nits: - 3'; d u . . . 4553 Swe "paiIt. 0 ?3 C €d r CI if i�ttAn6es: St PAL u). Ut f t i .4 lMAstdcr No,: rmer tion Chores, tI . _ w Siagr; t Rectifier No.t permit : 1► i . r ► ee r wa the Surchorgec .. , : Vitt Misc. Cher', ' �k� Total: Date Paid: Irk.. • crrr OF swami SEWER SERVICE PERMIT 117121.1Pilet K+t Reed PERMIT NO.: r �. illegsn, MN 55122 DATE: I ; L 1: , Zoning: r T i No. of Units: 1- (' fi ,, r t-r a ;'s nr S tGde Ad !r5 0 ,( 1 / 4 ynz1 T?z site AcWresc: Plumber : Iiti 1 1 /21 /21 22 +1'26 1 SONO >b whir die Cty M ghee Connection Charge: r , , _.,1 Oldinesoee: Account Deposit: Pemdt Foe: Surcharge: , • �; By / , fi Misc. charges: Date of {nsp ; . Total: Insp.: - '7- Date Paid Use BLUE or BLACK Ink r----------------� I For Office Use � ' � Permit#: C/� ���N j Clty of �a��� � �� � � Permit Fee: � 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax:(651)675-5694 i Staff: i 2013 RESIDENTIAL BUILDIN PERMIT APPLICATION Date: � � � Site Address: ���` '� ��;�11 {�-A�L-� Unit#: - Name: � � ] 1 Phone� y"�/t� Res�denti .�.: �� � � �`�'��Ouvner � ���� address i c�ry i zip: � � Applicant is: Owner Contractor ; Description of work: � Type of Work _: Construction Co� `� �� Multi-Family Building:(Yes,�/No ) °` Compan � ��1 °' L�� . Contacte� � �� Contractor ; Address: � ��� L..o�C��'!.� .��C City: � � ' State:� �S Zip. Phone: � License#:���T'���/� Lead Certificate#: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) ' COMPLETE THIS AREA ONLY IE 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: NOTE:P/ans antl supporting documents fihat you submit are consitleretl to be publ�c infQrma#ion Portions of :: the information►rray be classi�ed as non-public if you provide spec��c reasans,that would p;ermit the City fo` `, conclutle,that they.are tratle.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. vwvw.qopherstateonecall.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 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. , I 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. I ��. , �/ ' x� �l�iv�kS '1 i���� X , ApplicanYs Printed Name ApplicanYs Signa r Page 1 of 3