4312 Clemson Cir CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P.O. Box 21199 PERMIT NO.:
Eagan, MN 55121 - DATE:
Zoning: No. of Units:
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:
Ordinance Misc. Charges:
Total:
By , Date Paid:
Date of Insp.: _ 7 - , 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:
1 agree to comply with the City of Eagan Connection Charge: 25
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
i
Use BLUE or BLACK Ink
For Office Use---------
,
~~t j Permit 1 I j
Icy of Eap I Permit Fee: c, 5- o~
3830 Pilot Knob Road I I
Eagan' MN 55122 I Date Received:
Phone: (651) 675-5675 I I
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Fax: (651) 675-5694 1 Staff: all
`___-_____U______J
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: ((fit f ( ~f 3 0-13 lo~~Ytt SO,U 6~_Unit
Name: !P-a[ of Ao!✓4 A S ~l,-/ 14,L /9
M /'1 Phone:
Resident/
Owner Address (City /Zip:
Applicant is: Owner Contractor
I Type of Work Description of work: K~Qee pf ~t,0IwJ
- Construction Cost;_ v _ r.____.~_l~Qulti l amity ~aitdrflg~ {~`es / No-~--
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Company: Contact:
I Address: Ci3 ,Gfaf.a'16 _4.r0f,, City: Mo L
i Contractor ~ Ylr1~n ~ ~ra~-
State. Zip: Phone:" NAT.-
Lead I Liserfse#:- - - _ e i ica e .
If the, project is exempt from lead certification, please explain why: (see Page 3 for additional information)
D &1'v,,I~ - 5 f
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 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.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 l 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 Buildi Code must be completed within 180
days ofpermit~,issuance. x-1162~ V`t 1e x
Applicant's Printed Name Ap 'cant's Signature
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