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1274 Deercliff Lane - Service PermitsIT OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 Zoning: Owner: Address: 111111W -MI 111-1r WATER SERVICE PERMIT PERMIT NO.: DATE: No. of Units: Site Address: Plumber: Meter No.: Size: Reader No.: I agree to comply with the Ordinances. By Connection Charge: Account Deposit: Permit Fee: City of Eagan Surcharge: Misc. Charges: Tatat: Date of I nsp.: Insp.: /°5/40La,1, 0 � � 2 Date Paid: CITY OF FAGAN 3705 Pilot Knob Road Eagan, MN 55122 Zoning: Owner: Address: Site Address: Plumber: 1 agree to comply with the City of Eagan Ordinances. By Dote of Insp.: Insp.: SEWER SERVICE PERMIT PERMIT NO.: DATE: No. of Units: Connection Charge: Account Deposit: _ Permit Fee: Surcharge: Misc. Charges: Total: Date Paid: City of RaftaH 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 C \3 Date: Resident/ Owner Use B =E or BLACK Ink For Office Use 'ermd 11 1 Permit Fee Date Received: / ` 3 13 I Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION .7-53 1 Site Address: 1270 -• 7��--7 4 —76 De prcLrc-F- Ave - Type of Work Contractor Unit #: Name: vj t kin C \r• Ly T tJtJ � V�S: f' if'ukhone_ to I ' Z -r '1O Address i City i Zip: P. ©_ C2 -.341C Al bfi 7 . ink) Applicant is: Owner Contractor Description of work: Re- -RQ o Construction Cost: Multi -Family Building: (Yes y ? No Company: Rb Tib AG 5 e Contact: c ( R . yrfn „) 9 10 Co 1^ t City: 0 �ij "�` LI4�}&L; Address: State: %it( zip: 5 VI L, Phone: (n 1 Z 210 _ 1 6C, y License #: 13(. 59 5 7 68 Lead Certificate #: -8iT91-1 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 yesdate and address of master plan: Licensed Plumber: Mechanical Contractor: Phone: 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 Cali at (651)454-0002 for protection against underground utit ty damage. Call 48 hours before you -emend lo dig lo receive locates of underground utr6trcrs I hereby acknowledge that this informat on is complete and accurate that the work will be in conformance with the ordinances and codes of the City of I acran Thal I understand this is nom a permit:Lit only an application for a permit: and work is not to start without a permit hal the work t+il he 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. Applicant's Printed Name 1 Applicant's ignature