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4723 Tana Pt WATER SERVICE Pte: litt,f-iiii Kook Reed ' PERMI1 N©• " 3 " : ." SIN 55122 -DATE: , ,/; i r E No of Um= 1.. Unit, 1 of r :.5 i er: Orrin rfhorapsorl ,ktre• ' Address: - 7 '_1.'ana F ,_j• 'B7—Eid Cij f'fe , `x Ptunnber: Genz Ryan i : Meter Wo.• Connection Chorge: 105. ou fir4 Size: - Account Deposit: trader fiNo.: Permit fee:. 10. pd : . 50 P M aM� Wilk Os City a�f Nora Surcharge; Mist. Charges: .41{1 1 " i ?te fkarmaA Total: Dote of Insp.: l insp.. x P1 PERMIT NO.: M � cE � ' P MIT • -iii*• MN 55122 ,; E kTE s :, / : TT No. of Units: `�`� �� +x'7.4 � %` Owner: C 7 1 ( - 7 Add►esx Site Address: * 4 7 2 '' ' rt 1,2 rq 0 ,11 . f jary I Pjt rnber: Genz Evan '7/1 1 9 8 73 100.00 i everts empty Wilt the City of g gen Connection Charge: 1125 00 pc' Ordinance& Account Deposit: Permit Ewe: 1(1, 'If? 7 Surcharge: 5:7) mac' By " Misc. (large*: Dote of Map.: Total: Insp.: _ Date Paid: Use BLUE or BLACK Ink r I For Office Use I ; Permit City of Eap I I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 ; Date Received: ; Phone: (651) 675-5675 I I Fax: (651) 675-5694 i Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: 7 3`~i'~ZJ /~s )V~y" I '7 ~10 ° 17(12 *10-"f C✓ee y Unit Name: 91"Mo Phone: Resident/ Owner Address / City / Zip: Applicant is: Owner Contractor Type of Work Description of work: °!fw Construction Cost: 2~~ ® Multi-Family Building: (Yes / No ) Company: ~ IeI Contact: C~ Le 4, o ,.,e Contractor Address: /3 v 5_ Oe 1oz-y l~?O- City: fs4_111C_ State: /1///? Zip: S-5-34 -7 Phone: License .:;LU3 C O 4 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 must be completed within 180 days of ermit issuance. xh s x Applicant's Printed Name Applicant's Signature Page 1 of 3