4436 Cinnamon Ridge Tr CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot K-nob Road
P. O.,Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: _ — 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 Eogan Surcharge:
Ordinances. Misc. Charges:
By O 4 / �1 Total:
�' ` ( V Date Paid:
Date of Insp.• i 7 - / .- 8 a •
Insp.
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot (Snob Road
P. 0. Box 21199
Eagan, MN 55121 PERMIT NO.:
DATE:
Zoning:
Owner No. of Units:
Address:
Site Address:
Plumber:
1 agree to comply with the City of Eagan Connection Charge:
Ordinances.
Account Deposit:
Permit Fee:
By Surcharge:
Date of Insp.: Misc. Charges:
I nsp.:
Total:
Date Paid:
Use BLUE or BLACK Ink
-
For Office Use
I
Permit
City of Eata~ I 1
Permit Fee:
I
3830 Pilot Knob Road I ROIL
Eagan MN 55122 i Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 1 Staff:
L - - - - - - - -
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: -3 e7l Site Address: L~~rv,Y W f/44.1 L Unit
Name: Phone: .fo~~` ~f eC
Resident/
Owner Address /City /Zip: --3 .rW f ~ f`D~I1~? rr 51001-3
Applicant is: Owner Contractor o
Type of Work Description of work:
i Construction Cost: Z i Multi-Family Building: (Yes / No )
Company: t~n33S~ c" e Aj S 7,i.t/®'Grcontact: I
Contractor Address:,~,~ S* 4,/1rett S4 _s x' o City:
State: Alt^J Zip: r+~ Phone:
License M Lead Certificate 2 7
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 maybe classified as non-public if you provide specific reasons that would permit the City to
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. www.gooherstateonecall.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 must be completed within 180
days of permit issuance.
x t L r? r ~Ar ri~ . 00 re x -
Applicant's Printed Name scan s ignatu `
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