1529B Clemson Dr CITY' OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob 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:
Total:
By L(, Date Paid:
Date of Insp.• ^/ Insp.:
CITY 'OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: —_ No. of Units:
Owner: —
Address:
Site Address:
----- - - - - --
Plumber: _ - - - -- ------- - - - - -- - -- --
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:
15a~ Ar.15a~ tayUse BLUE or BLACK Ink
I For Office Use I
I p I
j Permit#: 1
City of Eakan I 5 . ~s
Permit Fee: 1
3830 Pilot Knob Road p
Eagan MN 55122 j Date Received: lot i ~5 I
Phone: (651) 675-5675 I 1
Fax: (651) 675-5694 1 Staff. I
I I
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: C~ e f f f\ ~/Vy i f V Unit
Name: -n' I tJI I l U ~ ~ it r Je , ~ J , l l~ Phone: , G':< S _
Resident/ ` V~ /Vu 3-4&
Owner Address / City / Zip: 2 2
r
Applicant is: Owner} Contractor A
Type of Work Description of work: V V o (kwl vVtn G c t
Construction Cost: V Multi-Family Building: (Yes / No )
Company: 0- Qit inel Ca qd QE?`'r1ed ItAi `tt o)htact: ' l'i-A124til 1
Contractor Address: Cf)(-) G >L~ols/O v- Q%jd City: _S4. Lo LL State:h 'Zip: Phone: ESQ
License ~IC> ] CU 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 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.oor)herstateonecall.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.
12 ~ 71A d T-h 1 10 S~ XP
Applicant's Printed Name App ' is ig ature
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