1584B Clemson Dr CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. U. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: , No. of Units:
Owner:
Address:
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reoder No.: Permit Fee:
!agree to comp with the Ci of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By Dote Paid:
Dote of Insp.: lir Insp .•
11 s
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:
Ordinances. Account Deposit:
Permit Fee:
Surchorge:
By Misc. Charges:
Dote of Insp.. Total:
Insp.: Date Paid:
r
Use BLUE or BLACK Ink
I For office Use
I I
' j Permit#: 1►°~_ 1
t of Evan I .sa
3830 Pilot Knob Road Permit Fee:
Eagan MN 55122 Date Received: 0 j
Phone: (651) 675-5675 1 I
Fax: (651) 675-5694 1 staff.
2013 RESIDENTIAL BUILDING PERMIT APPLICATION?
Date: .16- 1(- 13 Site Address:6 1fga,q.) wig
)58 ` ----Unit
Name:.#~ ~
~l _7.64J -AQLM_eS_-_Phone: -2- 72L S't2 L_
Resident;/
Owner Address / City / Zip:
Applicant is: Owner Contractor
Type of Work Description of work: Ale_MQ f
Construction Cost Multi-Family Building: (Yes No
Company: R C0/7 Contact: i
Contractor Address:, 3a 1"1 t c?j7Gt,_-- _ City: Mf►fn> axz.
State: M Al_ Zip: 5'S~lo Phone: - Z - 5406 -
License S t^ - 1 ~ 10 6 Z- - Lead Certificate ~AT--:: 2 I f
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 the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aoohenstateonecall.ora
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 160
days of permit Issuance. r
Applicant's Printed Name L~ Applica f s Signature
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