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4530 Cinnamon Ridge Tr CITY OF EAGAN WATER SERVICE PERMIT 3795 Pilot Road PERMIT NO.: Eagan, MN 55122 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 Eagan Surcharge: Ordinances. Misc. Charges: 40 7 Total: By Dote Paid: Date of Insp.• d Insp.: CITY OF EACAN SEWER SERVICE PERMIT -3795 Pilot Knob Road Eagan, MN 55122 PERMIT NO.: Zoning: ___ _ DATE: Owner: -- No. of Units: Address: _____ Site Address: Plumber: 1 agree to comply with the City of Eagan Ordinances. Connection Charge; Account Deposit. Permit Fee; By Surcharge: Misc. Charges: Dote of Ins p.: Insp.: Total: Date Paid: Use BLUE or BLACK Ink I For Office Use 1 City of Ea i n Permit # - I I / I I Permit Fee: 1 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: 1 Phone: (651) 675-5675 Fax: (651) 675-5694 1 Staff: I I 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: L Site Address: « C vtAg, 0 -,J Q,4 Unit Name: JJ Phone: Resident/ Owner Address I City / Zip: Applicant is: Owner X Contractor c-~ Type of Work Description of work: l Construction Cost: Multi-Family Building: (Yes / No Company: C Contact: Contractor Address: A~l n: ity: d P State: Zip: Qc (L Phone: c6~ License C ~12 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 I (E In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? i _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: i I Phone: Sewer & Water Contractor: _ Phone: t. _ 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 they 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.qopherstateonecall.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 S ate Buil ing Code ust be completed within 180 days of permit issuance. x Applicant's Printed Name A licant's Signature Page 1 of 3