4689 Lista Pt CITY OF EAGAN WATER SERVICE PERMIT
3795 Pi :St Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner: - — Address: - --
Site Address:
Plumber:
Meter No.: — Connection Charge:
Size: Account Deposit: -- Reader No.: Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges: -
Total:
By Date Paid:
t
Date of Insp.• / D - / 2 Insp.:
•
CITY OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning:
— No. of Units: —
Owner:
Address: -- Site Address: _ - - -- Plumber: —
I agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
By Surcharge:
Y Misc. Charges:
Date of Insp.:
Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
r
For Office Use
411b~ Permit#: 1 j
City of Ea Eaii
Permit Fee. 0-7 ✓
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: TI d 9,1~p3 GSi Unit
79
Name: //JLI /'f t Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner Contractor
Description of work: `T/,)
Type of Work
Construction Cost: ~f 4 Multi-Family Building: (Yes / No )
Company:/&4*19'7 Contact:
Contractor Address: City: '67LIA0 0` e -
State: 01/1 Zip: 9 7 Phone: 6Z.2-
License d; ~3 S -"d 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
L 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 Minne State Building Code must be completed within 180
days of permit issuance.
x
Applicant's Printed ame pplicant's ignature
Page 1 of 3
Use BLUE or BLACK Mk �
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' � Permit#: ��� �
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� Permit Fee: �
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 i Staff: i
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:��—��Site Address:�6`'�j' �/��� �j/G�9 �S7'/� �T Unit#:
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� ��� ��� �„�� Applicant is: Owner Contractor
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��' ��� �� Description of work: ���
Type of Work ;
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���"' ������ Company:�����1'I �dh?� ��'1/ Contact: /�Lt. �,� 7`'i0,�'�L'
���Contractor�� Address:_ J��.D� ���'��LI� � c�ty: �/�c�'�'.��1ii�'�-e
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� .= ���` State� 1°� Zip: Phone: o�� '-" °Email:
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� �' License#:�3�t� C` 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:
��NO�TE�Plans and�supportrng,docu�i�ts that you�bm�t are`�cansrder�af�o�be�pu�lic►nfa�rm��;�on�,Pa�r#ia'ns�'a _�
�,�the rnformat�on rr�ay be�clas��fietl a no �ubl�c�f�yot�prov��le spec���"�eas�ans�#h�af� ,ou�d�pe # e���,` � •=
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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. wvuw.qopherstateonecall.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 �7 'Pi" � x
Appl nYs Printed N me �cant' ignature '�,
Page 1 of 3 �