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4714 Tana Pt f d f 55122 - ' ''''' DACt* - P 512 P 1 x ; (, dy er: S. ``Site . Add W. Read Pe JET � ` fl!► eE Sege* Su f.':°-1 - ?Xl fit? �- N!!R Mac. Charges By %� ` Date Patch, ate o f l ./ /i Inr.: ' SEWER savviest tERIAIT 4 3704 = µ - PERMIT =140 1! .n� DATE: - / „ "1' . +ngg: , P YT No. of Units: _ u ' ; l . C' -• r , rest: Site j . �� � w F sir ., _ , , i 1 ,, � "�' }e l✓1i.L _rF. 2 , plumber: 0/1:-/ + ' t' en z ?' S -a . _ 3 I ):,: 1 0: r1:'.r I agree to eorapily with Wee City of Sagan Connection : n r n Account Deposit: Permit fee: 1t' rv' Surcharge: r .,-, , r By Misc. charges: :t Tota 4, . pate Paid: t c— Use BLUE or BLACK Ink r For Office Use n Permit#: City of Ea ~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 I I //J'' ` 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: - Site Address: Unit Name: Y,711- `171S~ C"101P V710 " Y71'1 rte' lg~ll Phone: Resident/ Owner Address / City / Zip: Ijedee- Applicant is: Owner Contractor Type of Work Description of work:/! Construction Cost: Multi-Family Building: (Yes / No ) Company: 2 dm Contact: i);;l C Contractor Address: /✓~r ~~1~ e~ City: State: N17 Zip: Phone: 671 License U e) 16-7 Lead Certificate 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: 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 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.clopherstateoneGall.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. r X 'Dry/, X Applicant's Printed Name Applicant's Signature Page 1 of 3