3103 Farnum Dr CITY OF EAGAN WATER SERVICE PERMIT
1
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 s Date Paid:
Dote of Insp.: 5 -IT_ Insp.:
' CITY OF EAGAN
3795 Pilot SEWER SERVICE PERMIT R ood
Eogg MN 55122 T'
Zoni
PER NO.:
Owner: DATE
Address: No . of Unit
Site Address:
P lumber: � �_____-
I agree to comply with
. t6o City of Eagan
C onnectio n
Charg
Or dinance s .
Account Deposit:
By Permit F ee:
Dote of Insp.: Surchorge:
Insp. Misc.
Charges:
Total:
Dote Paid: --
Use BLUE or BLACK Ink
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City of���a� � Permit#: �
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� Permit Fee: �� �
3830 Pilot Knob Road
Eagan MN 55122 � Date Received: j
Phone:(651)675-5675 1 I
Fax:(651)675-5694 I Staff: I
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2014 RESIDENTIAL BUILDING PERM17 APPLICATION
Date: Site Address: Unit#: ��
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` ���� Name: � �1�t" �el�'i ��1�� Phone: �� ��t"�� "���4�
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� ' Description ofwork: �c..`���`.� �Gt � � �'
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, M s ; Construction Cost:<���"��'«� Multi-Family Building: (Yes /No T�
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���,�������: Address: Ciry:
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�` ` =��t State: Zip: Phone: Emaii:
�~.�: :�'�� License#: Lead Certificate#:
If the project is exempt from tead certification, please explain why: (see Page 3 for additional information)
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COMPLETE THIS AREA ONLY IF CONSTRUCTIIVG A NEW BUILDING
In the last 12 months,has the City of Eagan issued a pe�rnit for a similar plan based on a master plan?
_Yes �No If yes,date and address of master plan:
Licensed Plumher: Phone:
Mechanical Contractor: Phone:
Sewer 8�Water Contractor: Phone:
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CALL BEFORE YOU DIG. Call Gopher State One Call at(851)454-0002 for protection against underground utifity damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.orq
' I hereby acknowledge that this information is complete and accurate;that the worfc will be in conformance with the ordinances and c�des of the City of
Eagan; that t understand this is not a permit, but onty an application for a permit, and work is not to starf without a permit; that the work wil) be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
E�cterior work authorized by a building permit issued i�accordance with the Minnesota State Building Code m�t be completed within 180
days of permit issuance.
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ApplicanYs Printed Name Applic' s$ignature
Page 1 of 3 ,
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