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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 (� lec��- c.c,�.�1 �Q...C�4�- �C� "���3 a�-,��"`���w � Use BLUE or BLACK Ink � Forofficeusa w�^^^^__� I • � � (� � � ��7C 1 I C��� �� 1J��LL� 1 Permitdk � �j � � Permlt Fee= '�S � 3830 Pilot Knob Road � • ?J ( � Eagan MN 55122 I Date Recefved: � Phone:(851)675-5675 j I Fax:(651)675-5694 I Staff: � L----___._..._---------� 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 - � �� � �3 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 ' Page 1 of 3