1760 Bluebill Cir CITY OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eown, MN 55122 DATE:
Toning: 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:
Dote of Insp.: Total:
Insp.: _ Date Paid:
CITY 9F EAGAN WATER SERVICE PERMIT
3795 Pilot Knob 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:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total: _
BY ? Dote Paid:
Date of Insp.:��L Insp.:
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Use BLUE or BLACK Ink
For Office Use
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on Permit
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City of Ea
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3830 Pilot Knob Road Permit Fee: 14
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t Date Received: I 12 _ i
Eagan MN 55122 l
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Phone: (651) 675-5675 I Q~ Q, i
Fax: (651) 675-5694 I Staff. E~ IL i
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: 13 Site Address: I'M 1-7&o 17(q:l, 17Co. 17
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s Name. Phone:
Resident/
Owner ~ Address 1 City / Zip;
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i Applicant is: Owner Contractor
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Type of Work Description of work: ~Qy dJ++ rti
rrt Multi-Family Building: (Yes / No
Construction Cost: -17 ~~Q )
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Company: cr~1~@P t~-acs~lc+s6^. Contact:_ Dq_r
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Contractor Address: City: ! ° t+rle~t~~~
1 State: MN Zip: Phone:
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License #:-is(- <9 (.p b wy _ Lead Certificate A) P-F - JO ? ° l
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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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 +t£ Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public lnfbrmation. Portions of i
the Information may be classified as non-public if you provide specific reasons that would permit the City to
L conclude that the 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.
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 penult, and work is not to start without a-pennit; 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.
Applicant's Printed Name Applicant's Signature
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