4725 Lund Pt CITY 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:
I agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges: -
Total:
By .� "' Date Paid:
D. e of Insp.: 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: — —
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
B Surcharge:
Y Misc. Charges:
Date of Insp.: Total:
Insp.• Dote Paid:
Use BLUE or BLACK Ink
r
I For Office Use
PermitM
4111k non
City of EaRd 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: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 4 722 - Y7 j y Unit
Name: I6~ -rile ~/s r Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner Y Contractor
Type of Work Description of work: d
Construction Cost: Multi-Family Building: (Yes / No )
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Company: oA12-ejx t Oilve 9,';,,
Contractor Address: 3,-2-&5- S 1 PFi°Nz-,O 64- City: ~JLs.~ir 1 l
State: All, Zip: Phone:
License 903*® 6` 6 / 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. I
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 Code must be completed within 180
days of permit issuance.
x D6~ r . {~~'t' scy7 x
Applicant's Printed Name Appli s Signa ure
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