1656 Donald CtCITY C.1 EAGAN
WATER SERVICE PERMIT
3745 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•
I agree to comply with the City of Eagan Surcharge:
Ordinances. / Misc. Charges:
Total:
By/'? Date Paid:
Dae of I., /2•--13-- 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•
I 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:
City of Eapll
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #: L l,/ t t'J 'y
g.T
Date Received: & X713
Staff:
Permit Fee:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: < PO/Site Address: /6 6-9- , z L Unit #:
Resident/
Owner
Name. , j).;' J .FA/1:-.)69' Phone: �^ e
Address /City /Zip: ,/,-'. 1 .1 ' JJ .
Applicant is: Owner Contractor
T e of Work
yp
Contractor
Description of work: lieLU i /)//1/�
Construction Cost: 6 e9 Multi -Family Building: (Yes / No )
Company: $ Q/ / Contact:
Address: City:
State: Zip: Phone:
License #: Lead Certificate #:
Ftheproject is exempt from lead certification, please explain why: (see Page 3 for additional information)
r.------
In the last 12 months,
_Yes X No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and
the information
supporting documents that you submit are considered to be public information. Portions of
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.gopherstateonecall.orq
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 s • completed within 180
days of permit issuance.
x
Applicant's-Printed-Nafie`
Page 1 of 3
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #: �9�
/aa-
Permit Fee:
Date Received:
Staff:
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
eslderii�%
Ozrurte
Name: t .`',. // i -/ CaNC/ Phone: —P16/
/'
Address / City / Zip: i .I - k/. A
Applicant is: Owner Contractor
T Work
Yp®
trttip a
Description of work: / a �_ r;,?.��� ,r /
Wee
Construction Co f% �D Multi -Family Building: (Yes / No )
Cor tracitor
Company: Contact:
Address: City:
State: Zip: Phone: Email:
License #: Lead Certificate #:
If the project is exempt from lead certification, please explain why:
In the last 12 months,
Yes No
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
Phone:
NDi�� Flans . supporting� � - .
eumer ; hat you ubmit c re ie' public it a �q: s • Por
the in ormat, ® may be cla fled as non public ou p • , e ecidc reasons that n �d permit th #
Y t cp phial ; e red ade bets,
I of
to
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.000herstateonecall.orq
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. S!�Applidant's Printed Ngcid.
e
EAGAN
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 I TDD: (651) 454-8535 I FAX: (651) 675-5694
buildinginspections(c�cityofeagan.com
For Office Use I
Permit #:
C; -CO �4
Permit Fee:
Date Received:
Staff:
L
2018 SEWER AND WATER REPAIR / DISCONNECT PERMIT
J
Date: I + . /75/18Fee: $65.00
City Sewer City Water " Repair Disconnect
Description Of Work: ExC < , ,k f Sc ,g<, l', l-;,1 , Y ' e rV`. k j
Street Address for Proposed Work � `� �i �"� �`� Y �
owner Information
Name: j irul et -<,i ,,y Phone: i5-(1) V I'CI. Z,l 6 i
C `y 1
Address / City / Zip: 2 '1 31-..J j , L. v. 'w Ave,�`1Loste v / ° ,M V .J 5c» -1`f
Applicant is: Owner /Contractor
Licensed
Name: \L-1-1-'.,
Pipelayer Master Plumber / Property Owner
-1 ti r
Phone:
Address/City/Zip: H S3Li C'- 7) k Al ' {cllr' p -k5 MJti 55'4111
Pipelayer Training Certification Card #: or Master Plumber License #: rivA 0 i 161
I acknowledge that the information is complete and accurate and that the work will be in conformance with the ordinances and codes
of the City of Eagan and the State of MN Statutes. I understand this is not a permi but only an application for a permit, and work is
not to start without a permit.
/l�l41V CAS /
Applicant (Pnt Name) Applicant's Si nature
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email
update on the City's website at www.citvofeaqan.com/subscribe.
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.gopherstateonecall.orq