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—
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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
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