1363 Easter Lane VILLAGE OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.•
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner: �2' <�. F. .. i1? h " ::li)it 0.
Address:
Site Address: .1 r,p, s , ;
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:
B Date Paid:
Date of Insp.: Insp.:
VILLAGE OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning:
No. of Units:
Owner:
Address:
Site Address:
Plumber:
1 agree to comply with the Village of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By: Misc. Charges:
Date of Insp.: Total:
Insp.• Date Paid:
07/03/2014 00:05 r633237464 MERIT BLDG CO PaGE 01/10
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3830 Pilot Knob Road � • ?J ( �
Eagan MN 55122 I Date Recefved: �
Phone:(851)675-5675 j I
Fax:(651)675-5694 I Staff: �
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2014 RESIDENTIAL BUILDING PERMIT APPLICATION
� Date. 7 f 3�2 Q�� Site Addresa: � �J�� " � 3 �3 ,d a'J•�r'e.�" �O�.i��. Unik#:
Name: I�� I� �4-O�. l��"V C �� Phone: �.OG ( `�O�rJ� t�.��"��
Address/Cily/Zip: I 2 2,� TC�W sr"1 l Aa f"�t,'C�Q. �,. vQ��F r a�C, m�r -
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Applicant is: Owner Contractor
Description ofwork,�' '�� � �
Construction Cost: � � • �m 4 � Multl-Famlly 6uilding:(Yes � 1 No )
Company: 1 I lEC�� �� ! 0�\,�Contact:
3a� r �.f /� '��� �.��� �
Address: 2 y���� 1�A �,.�1l�L��' �.�.��n
+ ��W� �1 L t
State:��Zip: 55�3� Phone: ��0�-.�..�' Email: .!�1�Cw(Y�" �L'"1�'` (�iL.c4! �tlti�, 4
Llce�se#: � � � Lead Certificate#: L 3 � i � �
If the project is exempt from lead ce�tification, please explain why: (see Page 3 for additional infarrnation) ���"�
COMPLETE THS AREA ON�.Y(P CONSTRUCTING A NEW BUILDMI�G
In the last 12 months,has ihe Clty of Eagan issued a permit for a slmilar plan based o�a master p1anZ
_Yes No If yes,date and address of maste�ptan:
I�icensad Plumber: Phone:
Mechanical Contractor: Phone:
Sewer 8 Water Co�traator: Phone:
: �
CALL BE�OR�YOU p�G• Call Goph�r State One Cdll dt(851}45A-OOD2 for protection against underground uNllty damage. Call 48 hours
before you irrtentl to dig to reCelve locates of underground utilities. www-gooherstateonecall.or9
I hereby acknowledge that this Iniormatfon Is comvlete and aoeura4a:that the worlc wlll be in co�fOrmanCe with the ondlnances and code5 of the Clty of
�agan; that I understand this is not a permit, but only an appllcation for a permit, and work Is not to start without e permit; that the work wd11 be in
acCOrdBnCe vhth the approved plan In the case of wOrk whlch requlres a review and approval Of p��nS-
Exterlor work authorized by a building pertnit issued in accordance wlth the Mlnne9ota Stdte Building Code must be completed withln 180
d�ys o1 pemllt Issuance.
X 1 � � �
Applican Printed Name Applicant's gnature '
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