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
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