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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 ` Page 1 of 3