4427 Cinnamon Ridge Cir04/18/2014 13:53 7635193932
04/13/2014 12:33
7695193332
C!tyotEag,aii
3330 Pilot Knob Road
6.agart MN W1222
Phone: (651) 67S-5676
Fart; (651)676-5G94
PAGE 01/03
PAG 01/01
Use BLUE or SLACK Ink
FOr Otlles LI u
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q-T((&Iiy
Pond trod;
gate Rived:
Stall;
2014 RESIDENTIAL/PLUMBING Roam APPLICATION
Site Addrese: '7 9(9 o e r .
Date: 1-1• $ • �(
Tenant
•
t✓olrbDf
suit*:
Name, 5 P 1 w e- f i e rc e.- Phone: e j -5?o - YR 7
Address /cls Ttp 4ya,� Cl v>ny�v n IZ �c(� c C•1 e
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Nome:
�(�D� e ✓ r.idenee IWr „J.�m ii it
Address I l l5y- a 6� city 3 I y n'toLA-1-
stew
l -state: ,1 yi 0 zip: t5S W 7 Phone: _l to 3. ¶ r 3'0 `/
Contact: rCLIYI I' era. (e Email: c� ( �� 5� • (O'
'otywohc
_Vomit ire,.
NOW 1, Replacomerd Repair
beee dptInn of %yank:
RESIDENTIAL
_Water Healer
Lawn Irrigation (RPZ
Septis Syetem
New
_,. Abandonment
Rebuild Modify !Voice ^1Work in R.O.W.
Water Gediener
Add Plume/lig Photons ( Main /, L,ow+ar Lewd)
Water Turnaround
RESIDENTIAL FEES:
S:
$60.00 Water Heater, Water Softener, or Water Her an Softener (Includos 35.00 State Sncher a)
$130 .011 tAVll° Irrigation (includes 35,00 mirtartern Stale Surcharge)
$60.00 Add Plumbing FI3dures. &+anticgtsionahn C ', Waw Turnaround* (inc!ad 36.OQ Slete Surcharge)
'Water Turnaround (edd 5200 :00 if a Sir meter required)
$116.OI4 .I 3 ; ,az J .. ("S1i1a0 per as btnit) (includes County tee and SS.00.6tatte St^rrarstge)
TOTAL PEES $ Co 50.0
%^ ^ :R r err '`^!_.F DIG. Call Gopher;lt:drr Ono Cad at pal) 45F-0002for protociton against undmrgrmynd utility damage.
intend to diS1 to receive locates of underground rttllltlea.Mc niw.a-rwgwpsrai,I kegnmall.2t�4
I hereby ootmowledpo /rut thla inroiTor ,cn la carver, grd as trlero: inY lye :-1; rtti! by _ =Kafttr = ICI 11i Y1MV:'^x�n�� : y art r. d S aft ea CIV qT
Eagan: ttaL I. understand thin nor ra permit, .`,ut only an applcal7:-+ :Iv n porn:c, wgirx a:n:: ,.;; .. a !w:rrr::hut ;no uhtf:l rd;,;
accordance Wen Inn aper arer, pian in the tibSB of wont xS:la` refJtrirD ruvtcw rim agr'l' Stoi of °lens.
Anigioanes 10
''i=OR OPPICE USE ' Rimorw iiF yt' • •' .•4 .
•
•.Required.lnspeeUons; 'Wide!'
Groupe • IRoug _ _..
;Meter. Related' Vienna: : eiteteyi ;Rradin'E s •
�;.
CITY OF EAGAN
3830 Pilot Knob Road
P. 0.&'ox21199
Eagan, MN 55121
WAR S VICE PRAT
PERMIT NO •
DATE.
Zoning: No. of Units.
Owner: '-Vrit
Address.
Site Address.
Plumber
Meter No.: Connection Charge.
Size: Account Deposit.
Reader No.: Permit Fee•
agree to comply wi a City of Eagan Surcharge.
Ordinances. Misc. Charges.
Total -
By Date Paid.
Date of Insp.: - Insp •
CITY QF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P,. 0. 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.
Date of Insp.: Total.
Insp • Dote Paid.
Oct. 18. 2013 8:59AM Crest Exteriors 651-463-8095
4401 C!ty ef Eaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 676-5675
Fax: (661) 675.6694
P. 17
Use BLUE or BLACK Ink
For Office Use
Permit 0:
Permit Fee:
itign
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 1D-11-15 Site Address: 1
J
Unit #;
Name: d()seTNnielS p g -
Address / City / Zip: Li 2.77 C ( r `Y
Applicant is: Owner V Contractor
Description of work: r
Construction Cost jJ—
Company: �1�1e-� J , `�r le x 10. .Contact: t \'RQ 1 S
Multi -Family Budding: (Yes ^/ No
Address:
Slate: f iU Zip: .c41 /
ty; Of\P I
Phone: :'- G Z
License fit: 2 ZL-I 6 Lead Certificate it:
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 V No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Phone:
NOTE; • . x
as if e'l � ,r , r1.J1IT1!t irli5CLnI7 '
C►.efs.
CALL FIEFO_RE YOU DIG. Call Gopher State One Call at (651) 464-0002 for protection against underground utility damage. Call 46 hours
before you intend to dig to receive locales of underground utilities. vi!_a_o_0110.LslattiagII.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 this Is not a permit. but only an application for a permit, and work Is not to start without a permll; that the work will be in
accordance with the approved plan In the case of work which requires a reNew and approval of plans.
Exterior work authorized by a building permit Issued in accordance with the Minnesota State Buliding Code must be completed within 180
days of permit Issuance.
sj : t: d r: be ub/ic Infor
tat• 9ovktp.
X
Applicant's Printed Name
x
Applicant's Signature
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