1528B Clemson Dr CITY OF EAGAN WATER SERVICE PERMIT
3794 Pilot Knob Rood
Eagan, MN 55122 PERMIT NO.:
DATE:
Zoning:
Owner:
No. of Units:
Address: -- - -- Site Address:
Plumber: Meter No.: _
Size:
— — — — Connection Charge:
Account Deposit:
Reader No.:
I agree to comply with the City Eagan of Eo Surcharge:
Fee:
rge:
Ordinances.
Misc. Chdrges:
By '' Total:
Date of Ins Date Paid:
p.: (2 ._'— Insp.:
•
CITY OF EAGAN 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 h' 9 Connection Charge:
Ordinances.
Account Deposit:
Permit Fee:
B Surcharge:
Y
D Misc. Charges:
Dote of Ins
p.:
Total:
Insp.:
Date Paid:
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Use BLUE or BLACK Ink
I For Office Use 1
j Permit
City of Eakan I Permit Fee: C 7 1
3830 Pilot Knob Road I 5 S I
Eagan MN 55122 Date Received: 13
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 1 Staff: I
I I
- - - - - - - - - - - - - -
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: tr 1 I Site Address: 1 GZ `-P C6 elwv1 V NV t Unit
Name: 11~t11~ ~v4~ Phone:
Resident/ - ~o V) a - 1 ~
Owner Address / City / Zip:
f
Applicant is: Owner L Contractor
Type of Work Description of work: 2 u9 W R ~'~L OKI
Construction Cost: J ~200 - 0 ® Multi-Family Building: (Yes X / No
Company: ~c~ l a ~QQk-'I Qci an ,l K 21'1 VX L' I trt~ 14kontact: ' J , V 1
Contractor Address: city: _S4. LoLL C'ctr ~L
State: OA k , Z`ip: Phone: Q-- 1 ~/'S- -7,20
License n-,Loo 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
In the last 12 months, has the City of Eagan issued a pen-nit 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.gooherstateonecall.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 State Building Code must be completed within 180
days of permit issuance.
x V1 iAA d 5.~ x
Applicant's Printed Name App ' is ig ature
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