1380 Lakeside Cir A
C IT f -rt P AGAN WA SERVICE PERMIT
it , t
6 Knob 'Roa ` . PERMIT NO
ti ga . M N55122 - DATE: ; a
Z oning No. of Units:r , '1'P •I
Address:.'
...,,,Site f „ _ 1:.; !„2 '�
Plumber: - t , �- _ ,. _ ' " . ,� L � ?? A
s X i y - r i
Meter No.: s , Connection Charge
Size: Account Deposit
Reader No.:, Permit . Fee: x `3'' A
agreeto comply with the City of Eagan +'' Surcharge: £3
_ A
Ordinances. * rte F,
Misc. Charges: `
Total:
BY / Date Paid:
Date of Insp.: / I sp.:
CITY or EAGAN SEWER - SERVICE PERMIT
31 .85 - =blot Knob Road , PERMIT NO.:
: 2oga n , ' M N 55 122 DATE: ` +`
Zoning: ' a N of Units: =
Owner �-' �°- � „
Address
Site Address: � - _..
Plumber: e , i� , w ''-s - "c; . . <
1 agree to comply with a `City of Eagon connection Charge
Ordinances. count Deposit:
. nit Fee: ,.'
-- ---,i-4. .. 4 ,t urcharge :.
By Misc. Charges:
Date of Insp.: -� , Total:
Insp.: r i' - Dote Paid: ; `
07/03/2014 00:05 7633237464 MERIT BLDG CO PAGE 04/10
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Use BLUE or BLACK Ink
--�----------------�
� For Offlce Use �
' I Permit#: � "�"��`�" 1
U�Ir� oi ����ll i Permit Fee: I l��•�� i
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3830 Pilot Knob Road 1 3 � I
Eagan MN 55122 I Daie ReoeYed:
Phone: (651)675�5675 j I
Fax:(651)675�5694 � Staff: � I
L----�---------__—_I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
DaEe: 713 ����'-1 SiteAddress: I 3'? �- t 3 �� �G�,�,��cl�. C1r�,I_�Unit�:
Name: ��Cl I�v�'�C�. C�'�1 C'. �� Phone: lSJS� "���"' �� "�
Address l C(ty I Zip: I �2-$ �rc�4,�'f� �� �'►2 ��C'��4������.�°� m N
` �� i 2�
Appiicant Is: Owner Contractor
�, ,
Description of work•
Constnaction Cost: �O 0 m � Multi-�'amily Buiiding:(Yes X /No )
Company: �Et'��I�( 1��� ��'� ,���f�C�ntact: Glv 1 t`„�� �C�L�
2-3�� �' � �+�4-2'.�.C7� �
Address: c�r.�t� � �Z��..'�'s (V� CitY: _„��,,,��T1/�t C�0��
r-f ' .��'��
State:��zip:��� Phone: l�O+��.��' Emar�. .C'\'}�.f'(\ !`�� U�'�`�
V I�R
� 1
� License#: � � � Lead CertiFlcate#: :— 3 i � �
If the project is exempt from lead ce�tification, please explain why. (see Page 3 for additional infarmation) `�`�"�
COMPLETE Th#S AREA ONLY IF CONSTRUCTING A NEW BUII.DING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan7
Yes _No I�yes,date and address of master plan: I�
Lfcensed Plumher: Phone:
Mechanlca) Contractor: Phone:
Sewer&Wate�Contractor: Phone:
CALL BEFOR�YOU DIG. Call GopherState One Call at(651)454-0002 for proteCiion againsf underground utlllty damage. Call 43 hours
before you Intend to dig ro receive locates of underground utiliGes, www.aooharstateoneca ,ora
1 hcr�by acknowtedge V+at this in�ormaUon Is oomplete and accurato;that the wo�ft will ba in confamance with the ordinancas and codes of the Clty of
Eagan; N1at 1 undarstand thls Is �ot a permit, but only an applicati0n for a portnit, and work is not to start wlthout a permii; that th�work will ee in
accordance with the apprevod plan in the Case of work wfilch requi�s a review and approval of plar�s,
Exterlorwork authOrited by a bullding perm�t issued in accordance with the Minnesota State Building Code must be Completed wlth(n 180
days of pertnit Issua�ce.
X_(��s�,,u I . �Y10, X C:���-C� 1�' ,
Appllcan Printed Name Appl(cant's �gnature
Page 1 of 3
fi83-7w
F. C. JACKSON
uwo auavaroe
. . ' 11E010T[RiD YND[R LA1Mf OI 8T11Y[ 0/ MIMNis0T/1 .
LIC[NS[D M ORCINANCS OP CITY OF YiIQI[A/'OLJ/
aa+e cwsr sa,M srReEr 55417 '
' 121-3484 . . f
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I N[ROY ptRT1/Y TXAT TN[ AlOV[ 16 A TqU[ AMD ODRA[CT RAT Or A Bt111V[C OF
Lot'2,Blact 3.Ches Har Firet Additian,
Dakota County,Minneaota.
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Aa sunv[veo er we rHia 23id. DAr cw Jan. ?.o. 1978 !
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. F. C. AGKSON. Muw[soiw [aKrILwTwM. No. 9400
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