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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 ) ~~lh~'~ ~1'eYf 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 Page 1 of 3