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