4722 Lund Pt Ch'Y OF EAGAN WATER SERVICE PERMIT
3795 Pilot 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: _
agree to comp) with the City of Eagan Surcharge:
Ordinances. Misc. Charges: _
Total: —
By , / Date Paid:
D.- - of Ins...
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: - ---
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges: -
Date of Ins p.• Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use
Permit I
City of EaEd I Permit Fee: J~
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
10 /Q4/13
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: /6/23X:2 Site Address:", 101T 6Pf. 'V7'Z2, ~7W LL4,0 & Unit M
Name:A9^ 15r Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner 14
Contractor
Type of Work Description of work: 71 ky 4L0_ " 4Jf_
Construction Co $ a Multi-Family Building: (Yes / No )
Company: k4w_ :7~41I y4 4'tlontact:
Contractor Address: aaor d:Aetwe4,a of City: (9491 i/AVW 'C
State: - Zip: ~53M Phone: 4 /2-
License #:6 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.aopherstateonecall.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 Co ust be completed within 180
days of permit issuance.
x Z'-'~V 44M x
Applicant's Printed ame Appi 's Si ature
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