4714 Anne Pt ,, CIT�I.OF EAGAN WATER SERVICE PERMIT
3795 PiiiotKnob` 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:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges: -
Total:
B Date Paid:
Date of % �� I nsp.:
CiTT= CI* EAGAN SEWER SERVICE PERMIT
3795 Pitt `Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units: —
Owner:
Address:
Site Address: - --
Plumber:
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.: _ Total:
Insp.• Dote Paid:
Use BLUE or BLACK Ink
r
For Office Use
Permit
fiG
City of EaEd ; L[JOA5
Permit Fee.
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 I Staff:
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 7// 7 AJ ,/010t' 9"7 8 7 ^.Unit
Name: Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner Contractor
Type of Work Description of work: V e " re U
Construction Cost: J b Multi-Family Building: (Yes JC / No )
Company: l1A/ 7rt A ng- ~Y Contact: r=ib Doe
Contractor Address: `t~s' City: 6U~~
State: _AI Zip: .~S'3 Phone: 01 _ FIV
License 6 6 4 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:
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.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.
'a-41 gi=_ x x
Applic nt's Printed Name cant' nature
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