4580 Horizon Cir � � ,� �...� Y ' ER SCR � ` tr,,-...,
! Ewa,. ' PERMIT NO ,� �'f
Ep I DATE (-/ ej s
ZOeairig; , _ No, of Units: rte.
owner: 7 ,-,— : . .y - t- a , r x r t t r . f u
t
Address: .
Site Address: F€ e r a T '0 r'''f _ ^'ire°1 ° . 1 fr, 1:- iv,- arty:,
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Piember. � * � i�;T, , ,, s�c�r7� :' fcs�1 '�
Meter No,: -// 7 ./ �Ssk i Con i . Y .1 ° .
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Size: - .q 7— g.9
Accou posit:
Reader No.: Permit Fee: 1 r ;
1 terse to comply with the City 4 of Eagan ''Surcharge. , r.CF
Ordinances. Misc. Cho 6''.nn �,C L, )' �, Total,
By Paid: I
pate of insp.: $/ lisp.:
i
CITY KAGAN — , SEWER SERVICE PERMIT
3 Iel ' Knob Road PERMIT NO.: "== . '-
t n, o -
531 � u bATE: 6 / 1 y, r'
t RITI o. of Rlite:N 1/2 sh�
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Owner: Joseph Miller C
Address:
Site Address: 458 orizon Circ'l.e L6 C Mar E 4th
Plumber: stern Mechanic
a = ; p... \ 25424' J ry - 100.00 pd
1 agree to c o m p l y ' o f E o g r i ' , urge: 42121 pd
Ordinances: Account Deposit:
b A Permit Fee: a 10.00 pd
Suecharge: + .50 pd
}
BY 7 . .\ Misc.. Charges: 1
Dote , c < � . total I
Insp.: 7-7 ii ' , bate'' Paid:
City of Ea�all
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
r
For Office Use
Permit #: 1 f 1
Permit Fee: I`05.35
Date Received: I obw /13
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: a'zet'" / 3 Site Address: Licso Unit #:
Resident!
Owner
Name: Ciuero`t £ CIA 7At ra /1/ L- 6uja Phone: 6)Z Z3Z - Ve9.22.
1 be -
Address / City / Zip: y o l o zo
, k, ('j' "c
Applicant
pis: Owner )(Contractor
T e of Work
Yp
Description of work: /e )49
Construction Cost: 0 000 Multi -Family Building: (Yes )( / No )
Contractor
Company: CIO ) Je,��i(�.*iOlil .rr-C'. Contact: S7' 7V& tl a )`tom
. /4Vk' City: (>ubrit a k,j4h/)Z
Address: l � #1,—.1 e
f (� /,
State: ��/(/ Zip: ccliii Phone: l /03 "'�7/ f –00c72—
License #: 0 e(03,5-2/0/ Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_Yes %o If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information maybe 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.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.
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 Ste 6-4/4Th
Applicant's Printed Name
x fl G f
Applica 's Signature
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