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4308 Clemson Cir CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot knob Road P.O. Box 21199 PERMIT NO.• Eagan, MN.5512=f. DATE: Zoning: No. of Units: 1 Owner: Address: Site Addess: Plumber: Meter No.: Connection Charge: Size: Account Deposit: Reader No.: Permit Fee: I agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: To By Date Paid: Date of Insp.: 5 r7 Insp.: CITY OF EAGAN SEWER SERVICE PERMIT 3830 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 rr I - For Office Use---___-- Permit City of Ea aii c u~ ' Permit Fee: 3830 Pilot Knob Road Eagan' MN 55122 Date Received: O j Phone: (651) 675-5675 1 1 Pax: 651) 675-5694 1 Staff: I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: S(l~ 017 C7 4f ~t) If W 13 C (eAWN tf'l Unit Name: Wt n1~ L(----- d- dA Phone: i Resident/ Owner Address / City / Zip: Ql t~~ UL i Applicant is: Owner Contractor Type of Work Description of work: ~J AS C t ep 7 C -IdIlke Construction Cost;__ __..._.__~___Multi_arra.ily_~uild#ng ('fes~f-No- Com ari : 1 L8 Re, a4^ . h (#r !E p y ` Contact: I q3q). A/ K, t 1. + f `k City: I/Mni'"(Lo Contractor Address: (4 7 - 75 State: Zip: Phone: NA L-ieense-#~ Bgm_q - et as-Cert ic`f' aTe --77.21- 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 0- I the information may be classified as non-public if you provide specific reasons that would permit the City to 1.~ ' _ 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.aopherstateonecall.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 St to Building Code must be completed within 180 days of permit issuance. X_ x Applicant's'Printed Name Appli s Signature Page 1 of 3