4715 Tana Pt •
. , • , U 'fER SERVICE PERMIT
PI (at ir'.i PERMIT NO.:
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No of Units.•
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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
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Account Deposit:
Permit Fee: 3.
By Surcharge:
y Misc. Charges:
Dote of trip.: Total:
Date Paid:
Use BLUE or BLACK Ink
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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
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