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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 Page 1 of 3