4421 Cinnamon Ridge Cir CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: No. of Units: —.
Owner: -- —
Address:
Site Address: "1 n•i_ t'r Hi..,.
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
B /� / Date Paid: - -_
Date o Insp.— r6/ I nsp.•
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan; MN 55121 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:
Dote of Insp.: Total:
Insp.: Date Paid:
Oct 18 2013 8:59AM Crest Exteriors 651-463-8095 P. 14
Use BLUE or BLACK Ink
For UNIcA Use ~ I
I
I Permll
City of Ealan ; Permit Fee:
3630 Pilot Knob Road j
Eagan MN 66122 I Date Received:
Phone: (661) 676.6675 1
Fax; (661) 675-5684 Staff, 1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date; -1 Site Address; 2 1 Unit
Name: ~'A h UV ~1 y 1 1 Phone,
-=4 Address /City /Zip: =l
Applicant is: Owner V Contractor
Description of work: Re-ric
Construction Cost; Multi-Family Building: (Yes No,_J
Y' Q\`C1? X Ca`(1C~ .Contact:'(`(1ORP TV1CyCY1Q
Compan
Vii'..1..,:..
Address: a 4
0 0 ~w-
State:_ Zip: Phone: (91 Z ( 2
Llcense B ~~y 2 ZL7 U 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 ZNo If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor; Phone:
Q % PJhi-11 r~ sTi jo, jfi doWNW r `o"s'i' e'e ~o e' ubllc /nformationtion. ` " s:of
a, ~ a•~
e ~iifor a ?ma s s,~. ~t INot7 , at, &2,
'r~F.r -':r C9f1F 8 ,i„e3 e: Ct8 -
CALL BEFORE YOU DIG. Call Gopher State One Call at (861) 464.0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground uOlhles. www. o hers Il.or
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 Ihis is not a permit, but only an application for a permit, and work Is not to start without a permit; (hat 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.
X X
Applicant's Printed Name Applicant's Signature
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