1663 Donald Ct CITY OF EAGAN WATER SERVICE PERMIT
3830 Not Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: No. of Units:
Owner: _
Address:
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.• Permit Fee:
ogre to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
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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:
Plumber:
agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
B y Misc. Charges:
Dote of Insp.: Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
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For Office Use
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Permit
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Permit#: l —/ ✓"" `�
*) City of Eaall . -
Permit Fee. /SC
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651)675-5675
Fax: (651)675-5694 Staff:
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
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Name: 1 \ t Ni(, Phone:
Resident/
' Owner Address/City/Zip: 1 1' of " \a ( 1 I..
Applicant is: Owner 4-Contractor
Type of Work Description of work:`,,,,aUv\s - 5 , 1- pcklo (\do(i \ e 0\c.)6(2._
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�'Yy..e. St� c,��e- c5
C�r.dk S�`-�moi- ��.�C�k'Yl�
Construction Cost: Multi-Family Building (Yes /No )
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I Company:VK,k\C vac y c_0 Y C-A' Contact: I��k.--A._.
"1-10 r� k V\ l i,vd City: �L�_
Contractor Address: � �
Stater `\ ip: Li-kk•
one: \�.. t Email Ls.� I�GJOC .00VI'lS- ‘'lC
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License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING 1
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
I
Yes No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
1
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
I 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. .a..„,„.....,...........__._____„j
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 must be completed within 180
days of permit issuance.
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Applicant's Printd Name App s icant' Si9 natur-
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