4081 Meadowlark Ct VILLAGE `10F 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 Village of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By . Date Paid:
Date of Insp.: .27rigralir Insp.:
VILLAGE OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
I agree to comply with the Village 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
r_______________�-^.
I For Office Use �
� � Permit#: l u � I
Clt af ��pa� � k�� �
Y ° � Permit Fee: ��"' �
3830 Pilot Knob Road � i
Eagan MN 55122 � �
I Date Received: I
Phone: (651) 675-5675 � �
Fax: (651) 675-5694 I I
� Staff: �
�-----------------�
2014 COMMERCIAL BUILDING PERMIT APPLICATION
Date: C / ls t Site Address:
Tenant Name: {�� ���v...���� �;�����,/� � v� g�
Tenant is: New/ A Existin Suite#:
Former Tenant:
Name: {� �-e•.cM�,�n� X� �'\�i �� � � Phone:
Property Owner Address/Cit /Zi N��y , ti/^� � �f�, � aj�� I y�q?� {po�s'
Y P�_ '10.P1. `f qk3.�i ��j , ` , •
� �a�
A licant is: Owner ��`^�'v''^'i"`� C'�
pp �Contractor
Type of Wot'k ' Description of work _s�. r.��r�N� h i�w1�.,��
Construction Cost:�t S�2 Y��
Name:��v 1^�v�.�t�� ��� �o v.i`1►�c�iv^ License#: � 3�5� �
Contractor . Address: �� Q'�'� ������,� Q r. city: �/; ��.=.��
State: �`1 -� Zip: �S 3 c�' � Phone: G S� - d �j ° �� b b
Contact: %he �'�'� � e� Email: .�. , ?r.
� � J� �-Q�...;�.�,�.
Name: Registration#:
Architect/Engineer Address: City:
' State: Zip: Phone:
' Contact Person: Email:
Licensed piumber installing new sewer/water service: Phone#:
NOTE:Plans and supporting documents fhat 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 fo
conc/ude#hat the are tracle 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.qoqherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the w rk w�l be in conformance with the ordinances and
codes of the City of Eagan; that I understand this is not a permit, but only an ap c tionifor 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 r whi h requires a review and approval of plans:
x `/�e ��� g v� s e.^, X
ApplicanYs Printed Name ApplicanYs Sig
Page 1 of 3