1333 Easter Lane VILLAGE 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 Village of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By Date Paid:
Date of Insp.: Insp.:
VILLAGE OF EAGAN SEWER SERVICE PERMIT
3795 Fsilot Knob Road
Eag. MN 55122 PERMIT NO.:
on
Zoning: DATE:
Owner: No. of Units:
Address:
Site Address:
Plumber:
I agree to comply with the Village of Eagan Connection Charge:
Ordinances.
Account Deposit:
7 Permit Fee:
By:
Surcharge
Date of Ins Misc. Charges:
p.:
I
Total:
nsp.:
Date Paid:
07/03/2014 00: 35 763323?464 MERIT BLDG CO P�GE 01/03
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Use BLUE or BLACK Ink
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3830 Pilot Knob Road I � �
Eagan MN 55122 I Date Recelvod: �
Phone:(851)675�5675 j I
Fax:(651)675-5694 I Stia� r_I
L_...._ .... ---------
2014 RESIDENTIAL BUILDING PERM�T APPLICATION
pa�: 13 �2 U i� Site Address: � 33� -- I 3 3� �, 5�.��' L o..r1�. unrc u:
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' ! ' ����:� Appllcant is: Owner �Contractor
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';;` ! � Description of work l'�C"?'"". ;� �'��';�
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�'��I !`!���;" Constructfon Cost: y �o d Multl-Family Building:{Yes � /No,^}
,N ', � ' �� �: Company: !� Contact: 1...)O�V 1 Pti �[1.U1 —
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„'�` � � Address: 2-� J �.c��7, ���.�,�ic .�� �V � City. �C-��"')!1 d.,L�I
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�� �;"� I 'NII4 State:��Zip: �� Phone:�]�Dti-.��',���ail: (�1E.l���C�'�,`(LI�1"� b�.tt��� Q
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If the project is exempt from lead aertification, please explain why: (see Page 3 for additional infar�mation)
COMPLETE TMS ,AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the City of Eagan issued a permlt for a similar plan based on a master plan?
Yes No If yes,date and address of master plan_
Llcensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer�Water Contractor. Phone:
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CALL BEFORE YOU nIG� Cell Gopher State One Call at(651)4540002 for protection against underground utlllty damage, Ca1148 hours
before you Intend to dlg to receive IoCetes of underground utill6es. www.qopherstateonecall_ora
I hereby acknowiedge that this intormatlon Is complete and accurate; that the work wlll be in confomnanCe with ths otdlnances and cOdes of the CUy of
Edgdn; that I understand thls Is not a permit, but only an appllcation for a permit, end work is not to start without a pe�mlt;that the work wi�l be in
accordanCe with the approved plan In the case of work which requlres a review and 8pprovel of plans.
flxteriorwork authotixed bya bullding permR issued in e�CCOrdance wlth the Mlnne9ota State Building Code must be completed withln 180
days of permlt Issuance.
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Applican�rinted Name Appllcant's gnature
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