923 Oakwood Heights Cir CITY OF EAGAN WATER SERVICE PERMIT
37!5 Pilot Knob Rood 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:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By Date Paid:
D. of Insp.: — � - Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
37M Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 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:
Dote of Insp.: Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
-For Of-RceUse
j Permit
City of Eqan I ~ oat
I Permit Fee: I
3830 Pilot Knob Road
Eagan MN 55122 Date Received: j
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I I
~.----------------J
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: ltiZ Site Address: D
Name: 4''Atrtnus (CQ/U+JkSj- e_C&h hone: o ~ c..
Resident/
Owner Address / City / Zip:
Applicant Is: Owner Contractor
Type of Work Description of work: re --k=24
Construction Cost: 1 , Mufti-Family Building: (Yes ! No
Company: tiJV*: Contact: VoyeL
Contractor Address: 7,0 ,u_ city:
State: a r J Zip: o ~r 1,3 Phone: 2,10 -1
License 3Q_ 5 q S -7 4 9 Lead Certificate AJJ*N-
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.
CALL BEFORE YOU DIG. Call Gopher State One Call at (661) 464-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstatoonecall.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_ k)t-~ 1-C ?Jv~cati+ -iSr-f x 044 Applicant's Printed N Applicants ignature V 'V_
Page 1 of 3
Use BLUE or BLACK Ink
r----------------�
I For Office Use �
' � Permit#: /�(��� � � j
City of �a��� � �o�: ��-�
� Permit Fee:
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax:(651)675-5694 I Staff: I
I �
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: rJ � Zo Site Address: _ . � �� f10 HC.'1 C�j" Unit#:
_,,,,__ �e�+.� /-,���v�S
�;� �; Name: 17�' A/Qp � �►�cc��1.'{'� Cb�ornW�u%,�.. , S , Phone:�1 — c� TV—t�Zf 3
Residei�t/ , °
�=�Owner � adaress i c�ty i z�p: d fF�fC.w oo� -F��a h-4e �Y �(�- F 1`�4C�/t�
� #
{ ,
Applicant is: Owner �Contractor
� � ` Description of work: �f N 0 Gu {�e�d...�.1(°�mPn�'�
Type of Work —�
` Construction Cost: �� Q � Muiti-Family Building:(Yes�/No )
� Company:� 1��U`}' `t'� -t—�.�SC� �C _ Contact: �X�ctX�� (�c �nr�v--i�
. —
Contractor ��� Address: 2 (� � �� city: � ���4�
/�� N�e
State:�Zip: �S'�i 2� Phone: (a(Z-2.(0--�(p���ail: �V'I �n,�1��'�d� V���,��—
License#:� O 5�� 7�0$ Lead Certificate#: �(1'4-'�~�r', ����1` (
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 8 Water Contractor: Phone:
NOTE P/ans,and supporting,tlocuments#baf you subm�t are cons�dered fa be publ�c rnformat�on Portrons�f
the�nformat�on may be class�fed as non-publ�c�f you prowde spec�fic reasons that wou/d perm�t t�e City�to
�='con"clude'that the` are�tratle secre#s-;-: '. � ;` {�$ `
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.qopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate;that the work will be in conforma�ce 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��e L�S �� v�,n e�-�� x��.l, A c��;�;���'_�
A p pli anYs�ted Name �� A p pli c ant' Si gna ur�l v
Page 1 of 3