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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 - - - - - - - - - - - - - - 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 Page 1 of 3