1598 Mallard View CITY OF EAGAN Permit No: Date:
X830 Pilot Knob Road Meter No: Size:
P.O. Box 21199 Reader No: Date:
Eagan, MN 55121
Owner.
Site Address:
Plumber.
Conn. Chg: Zoning:
Acct. Dep: No. of Units:
Permit Fee:
Surcharge: I agree t. omply with the City of Eagan
Tr. Plant Ord' '
Meter: / f�
Misc.: _ B - ' /'���'✓
WATER SERVIC PERMIT
•
CITY OF EAGAN Permit No: Date:
3830 Pilot Knob Road B/P No: Date:
P.O. Box 21199
Eagan, MN 55121
Owner:
Site Address:
Plumber:
MWCC: Zoning'
City Chg: No. of Units:
Acct. Dep: I agree to comply with the City of Eagan
Permit Fee:
Ordinances.
Surcharge:
Misc.' By
SEWER SERVICE PERMIT
-
I For Office Use I
r 7~ Cit of n Permit `I Z7 3 I
I Permit Fee: a 5 I
3830 Pilot Knob Road I l
Eagan MN 55122 Date Received: Q
Phone: (651) 675-5675 I 1
Fax: (651) 675-5694 l Staff: 1
I
1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:: / Unit
Name: qs- Phone:
Resident!
Owner Address /City /Zip: /y`/tip d Vrc. C,.1
Applicant is: Owner A( Contractor
Type of Work Description of work: ro0
Construction Cost: 000 Clio Multi-Family Building: (Yes No )
lell"i
Company: Contact:
Address: ty:
Contractor ~N r Jc ity:
a
State: P Zip:
JP ~ Phone: 63
License SG CM 63Lead Certificate Fthe 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:
I - -
Licensed Plumber: Phone:
t
l Mechanical Contractor: Phone: I
Sewer & Water Contractor:
Phone:
I 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.gopherstateonecall ora
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~ty/`6 c bdf~ x
Applicant's Printed Name Applicant's Signature
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