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1321 Easter LaneCITY 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 Date Paid: Dote of Insp.: % r`•fl� sp.. ra95, plot Knob Road gon,M Zoning: 55122 Owner: Address: Site Address. Plumber: ee Ordinances. dgnonc to with the City of Eagan SEWER SERVICE PERMIT DATE: PERMIT No No, of Units: Connection Chorge. By Account Deposit: Permit Dot 'P.e= insA.: Surchorgeee Misc. Charges: _�— Toto/: Dote Poid '41'6 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 #: Permit Fee: Date Received: Staff: 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: S /' (' T Site Address: /J Z / �i4Stitr if,„, /31 J 4, , /. ,/ 43,, jinit #: Resident/ Owner Name: 401' 04- _3.94 G9/r Phone: a/ Z ' 7 Z5— //�� Address /City / Zip: /J / (e9/t/s cn! Ce9 k_ Cevr Applicant is: F. Contractor Type Of WOrk �/OOwner /f Description of work:/'Z /.49.s (L K._ S -'d �/V4 4/�1rt % /'�,0', �� Construction Cost: J Multi -Family Building: (Yes /( / No ) Contractor Company: A14—en 7 6,44/ c 0.9r,egik✓ 0' /e•ontact: 4' Ar..—. Iri.'%'a.., Address: y cf31 )7i !-4:10 t`- Cr City: S :: StateZip: S'% -J Phone:6� i—d 7 ?6 Aail 4B--/€4ls dr-Nr0. ..erV Z Can License #: 66.6 I'?'' ‘Ild Lead Certificate #: '/eAtriir id G4-3 ?gyp( If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, Yes 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 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.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 plan Exterior work author ed by a building permit issued in accordance with the Minnesota St• - Building �emust be completed within 180 days of rmit issu ce.4611g/ �/� A" -e--•------- x ......L..4 dr, A plicant's rin ed Name Appl cant's Signature Page 1 of 3