4472 Cinnamon Ridge Tr CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
F. O. 3ox 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:
I agree to comply with the City of racoon Surcharge:
Ordinances. Misc. Charges:
Total:
By / Dote Paid:
Date of Insp.: Insp.:
4
• EAGAN SEWER SERVICE PERMIT
4830 Pilot Knob Road
P. O.'Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE: _
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
I agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.• Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
.y For Office Use
a ;br' I Permit a 3/ I
City o End I Permit Fee: '
I I
3830 Pilot Knob Road I I
Eagan MN 55122 I Date Received:
I I
Phone: (651) 675-5675
Fax: (651) 675-5694 1 Staff:
I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: Phone: 4!~.f. d e
Resident/
Owner Address / City / Zip: "f t ..f'"
Applicant is: Owner Contractor
Description of work: /c -
Type of Work 1 10,
Construction Cost: Multi-Family Building: (Yes / No )
4. r tt.r~:_,xF,; .
N~l ~D+~iS~`C~Rtw+tfr'G~'ntact: ,r a~ rrc
Company:
I Address: y' ; -~►t r t City: M 4 IV r
Contractor
State: Zip:. Phone: 4642- +
License 13e° o~ Lead Certificate IV,4-7- 3 7 1 - /
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 may be 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.oooherstateonecali.orq
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. f
x r Z L° i.$ . c x
Applicant's Printed Name Applicant's Signature
Page 1 of 3
Use BLUE or BLACK Ink
1:, I For Office Use
d: i6r j Permit ) " 55 I
City of Ea a~a
Permit Fee:
3830 Pilot Knob Road j I I
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff:
L - - - - - - - -
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 7~ ~'i(l/v e~ L Unit M
Name: Phone: 4!~°
Resident/ /
Owner Address /City/Zip:
Applicant is: Owner Contractor
Type of Work r Description of work: ~L (A-,--Z- i)22 C)
Construction Cost: Multi-Family Building: (Yes / No )
Company: R A.+ i~tltC" ontact: /'r FF`f
1°~? f
Contractor Address: 20 '"F? i o City: 1k,
State: Zip: q;'Of Phone:
License Lead Certificate /144094--27434 )°2 -
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 may be 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.gopherstateonecall.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 complet m
days of `permit issuance. ~~qyxl
Applicant's Printed Name Applicant's Si TS.
Page 1 of 3