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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 Page 1 of 3