Loading...
4715 Tana Pt • . , • , U 'fER SERVICE PERMIT PI (at ir'.i PERMIT NO.: i ril Iii 71!,24 . DATE: `� _ I s; No of Units.• - OWn4r; Orrin _rillo :LR � es _ +. Ta.n4Pt L3 B6 Midge CUf'fe 2nd . GEnz Ryan ' - . * - �tNiflBGt 5.0 pd JIW Account Deposit: *r No.:- - Permit Fee: LO.00 _� '+N a#t tlM Sd!f► of kgsa Surdwrge: ', c M sc. _ 60,00: meter Totpl: ary MM '' SEWER SERN1 SIT 2795 Met Kee . Road PERMIT-NO.:- ' . - -- loom MN 55122 DATE: Zoning I No. of Units: Address: Site Pkunber. Hass. i } f r e c z t t l • 1 wee h t oompy WO the sOty of Bosom Connection Champ, Account Deposit: Permit Fee: 3. By Surcharge: y Misc. Charges: Dote of trip.: Total: Date Paid: Use BLUE or BLACK Ink r For Office Use Q Permit City of EaEd Permit Fee: U y 3830 Pilot Knob Road Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: ~tll -Y71 Xwif 6," ) Unit Name: ~/JG~ct, t1'- / st Phone: Resident/ Owner Address / City / Zip: Applicant is: Owner Contractor Type of Work Description of work:U rc1 v Construction Cost: 5 v Multi-Family Building: (Yesx / No ) Company: Contact: Contractor Address: City: / State: l! Zip: Phone: License ~ki~ 6 & -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.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. x 4,el x r-- Applicant's Printed Name Applicant's Signature Page 1 of 3