4433 Lynx Ct CITY OF EAGAN Pi/ - 514 e-d WATER SERVICE PERMIT
3 3O Pilo: Knob Roa Z - Z g9
P. O. Box 21199 S � PERMIT NO.•
Eagan, MN 55121 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 Hsi City of Eagan Surcharge:
Ordinaneu. -70 Misc. Charges:
Total:
By C` -^ Date Paid:
Date of Insp.: '/- 2 9 -.4- Insp.•
CITY OF EAGAN SEWER SERVICE PERMIT
3330 PiIdt Knob Road
P. O. Box 21199 PERMIT NO.•
Eagan, MN 55121 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:
Surcharge:
By Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
For Office Use
t rs - I ]
Permit l ~-7U`
Win
City of EaRd
I Permit Fee: 5 I
3830 Pilot Knob Road I (~1
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: Unit M
R rrl(Y-kl.1 O eFkkjec Phone:' 6I;~- 710- YTOO
Name:
Resident/ t~J
Owner Address / City / Zip: 1 33 1_ w r~x Cdr, L. (4 t,- w L
%J J
Applicant is: Owner Contractor
Type of Work Description of work: -Te,&
Construction Cost: mod Multi-Family Building: (YesX / No
Company: A-,O(pa- &&,Ikoe~j ontact: :il'ua~
Address: City: iLso rnd/VS'1-6
Contractor
State: (1Q Zip: SSY 3 I Phone: ~1' 2l 2- 3 1~
License 606,15 < O 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:
DOTE: 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 Code must be completed within 180
days of permit issuance.
x x ^
Applicant's Printed Name App cant's nature
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