4754 Flora Dr CITY OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.•
r.agan, 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 ` +L/ Dote Paid:
Date of Insp.: 9 •"1/ Insp.:
SEWER SERVICE PERMIT
CITY Of EAGAN PERMIT NO.:
3795 Pilot Knob Road DATE:
Eagan, MN 55122 No. of Units:
Zoning:
Owner: _
Address:
Site Address: - - - --
Plumber:
I agree to comply with the City of Eagan Connection Charge:
Account Deposit:
Ordinances. Permit Fee:
Surcharge:
Misc. Charges:
By
Total:
Date of Insp.: - -- — Date Paid:
I nsp.:
Use BLUE or BLACK Ink
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For Office Use 4 J
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3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651)675-5675
Fax: (651)675-5694 Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: ' .Z5V F/b✓✓k— inr�\(�� Unit#:
Name: kZ G 11-1 le• ifI ..._ _..._... Phone: 1S-]— 9'4.2-
Resident/ ��
Owner Address/City/Zip: �> Vb t-,ey.
Applicant is: x' Owner Contractor
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Type of Work I Description of work: Re ✓e0v ic- f S'e : r -4,--iv
Construction Cost: OOMulti-Family Building: (Yes I," /No )
Company: 1,(0. jfSI)C4eeT Y-C'Ti Contact: Ail—— 0/.// yr 6Si")Y4.--,!'g /
Address: //372- Gtftt4ZE 4 n )4.4eLt/V 7 ce 1//l,{Q)
Contractor
State: /Llyl.Zip:537J- f Phone: 1S%—?Y --Myr Email:F & Ayr 6, r'*,,,,
License#: D` Z 2. f fi 2-2 Lead Certificate#:
If the project is exempt from lead certification, please explain why:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: 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
i conclude that the 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.qopherstateonecall.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 plans.
Exterior work authorized by a building permit issued in accordance with the Minnesot ate Building Cod> st be completed within 180
days of permit issuance.
x L(( 1ti1 x / f"I CZ
Ap licant's Printed Name Ap''icant's Signature /
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