1614 Clemson Dr CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P.O. 6.9x 2I 199 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:
Ordinances. Misc. Charges:
Total:
By � Date Paid:
Date of Insp.: / 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: 4
Plumber:
I agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
By Surcharge:
y Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
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Use BLUE or BLACK Ink
For Office Use
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nj Permit
t City of EI Permit Fee:
3830 Pilot Knob Road I I f j
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Eagan MN 55122 Date Received:
Phone: (651) 675-5675
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I Staff:
Fax: (651) 675-5694
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 3 Site Address: o? 1,3 & IM 1 C 1eAs~ Y1e Unit
Name: / I / _LLOILAO-S 4)~ Phone: Co.1a 7L/-7 -IS cat' /
Resident/
Owner Address / City / Zip: )30UC
Applicant is: Owner Contractor
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Description ofwork: e T ml Jr PDOC ;,~ff!J~e f /A?
Ype of Work
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ConstructionCost: 1,~
i Company: " Contact:
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Address: City:
Contractor i
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State: Zip' Phone:
-ticense # - ea e i icate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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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.aopherstateonecall.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 ate Building C de must be completed within 180
days of permit issuance.
x 1sl~ S x
Applicant's Printed Name Ap cant's Signature
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