4715 Anne Pt GAN WATER SERVICE PERMIT
ilOtACrrob Rbad PERMIT NO.:
, MN 55122 DATE:
_oning: 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 Insp / _. 11 7 Insp.:
CITY Off, =PAGAN SEWER SERVICE PERMIT
3793 Pilot—knob Food 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:
B y -- Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
•
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use
r
a~ ; Permit#:
City of Ea q-1
o R
I Permit Fee:
I
3830 Pilot Knob Road
Eagan MN 55122 Date Received: 1'~
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
_
22013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Irn 13 Z 1 Site Address: T 7~1 7 y71'0 y71y O Pt Unit
Name: AIJ060 1 pw- 4g Phone:
Resident/
Owner Address / City / Zip:
Applicant is: Owner X__ Contractor
Type of Work Description of work: #J-,0 V
Construction Cost: ,0O0 Multi-Family Building: (Yes / No )
Company: laic o~9 d _,jtA AK 4"!tr7ebhtact:
Contractor Address: 3212E %S ;W/ff; V~ e: X1_ e4 P City:"
State: Zip: J 337 Phone: (Ol~' y ~~a J
License n ai 6 G G 7 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.-qopherstateonecall.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 ust b completed within 180
days of permit issuance.
x x
Applicant's Printed Name Ap ant's nature
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