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1923 Gold TrCITY OF EAGAN WATER SERVICE PERMIT 3795 Plot Knob Road PERMIT NO.: Eagan, MN 55122 Zoning: DATE: Owner; No. of Units: Address: — — — Site Address: Plumber: Meter No.: Size: Connection Charge: Reader No.: Account Deposit: _ I agree to comply wi the City of Eagan Suurchhar Pa Fee: Ordinances. ' rge: Misc. Charges: By — Date of Ins Date Paid: P • Insp.: CITY OF EAGAN SEWER SERVICE PERMIT 3795 -Pilot Knob Road Eagan, MN 55122 PERMIT NO.: Zoning: DATE: Owner. No. of Units: Address: Site Address: ----- Plumber: 1 agree to comply with the City of Eagon Connection Charge: Ordinances. Account Deposit: Permit Fee: By _ Surcharge: Date of Ins Misc. Charges: p : Total: Insp.: Date Paid: __ City of Ea�all 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 i- 77 7 93 - J 7- J q/ . , Use BLUE or BLACK Ink For Office Use 1 I5c 7S Permit #: Permit Fee: - 5 7, 75 Date Received: c//(335// Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION L. Date: 5/A /13 Site Address: 3 8"S 3 9 S 1 bLo yst # • -E Q . Unit #: Type of Work Contractor Name: cAn Phone: 76 - s 3 - 9 � 7 0 Address / City / Zip: 'S' h fo c +4 '3'—rJ ,Q ,q,, , t, aci.b E, m-43 s'3'4'.7 Applicant is: Owner is Contractor Description of work: T"E.42 C7-;1= Construction Cost: /3 7 Or' -°-.° Multi -Family Building: (Yes )C / No ) Company: cSE. / £�'i-c12,olc /%'%fh..; eP Contact: V1v�� v P ---k Address: 90 s VI:" S"T . City: PL S . State: /21Ai Zip: 5s'9/9 Phone: to`2' b'E'/— .2113 License #: / / Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) L E 2L Pos / 9 757 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: 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 penult the City to ;- conclude that they 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.gopherstateonecall.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 Minnesota State Buildin Code must be completed within 180 days of permit issuance. x ALI; u 2_14 t3 Applicants Printed Name x Applicants Signature Page 1 of 3 4,1`City otEgli 3830 PUot Knob Road Eagan MN 66122 Phone: (651) 6754676 Fax: (651) 675.6894 Use BLUE or BLACK Ink For Office Use Pem,rtat_11 ')-61`( Permit Fee: x'"13:° Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 3- ,1 N- )4/ site Address: P721 r• f , GoL13 13'1 "i lot_' M .-�r D _- Unit if: Phone: 743 - S'% 3— 97 7 0 Re&dent! Owner Name: ejo 4e A et 0.(E...)-7— XZi c., Address/City/Zip: 850 Corr' V2 A✓, A)• 2A 6oc.D£,J 1/441,sY /t,J Ss itel 7 Applicant is: — Owner kConbractor Type •of Woric, Description of work: (40.-e . £ a. RE Pc. 4-c.L 1• / 6 d '4-s€' a /4 E rig L Consbucdon Cost /14 4100 Corotraator Multi -Family Budding: (Yes X / No ) Company: Q E. I £,e. ' t'.ei n /Z MAI if. Lo alt Contact b4,,, 0 13,2.12.d S Address: qcs' L3 (Po II.S� , city: m PL S State: /1?0 Zip: 53-4/./ Phone: L0i2' 861_6"2V3 License*: CS - Z 4/11 / Lead Certificate #: If the project Is exempt from lead certification, please explain why: (see Page 3 for additional information) t�e.ta�S- q��c,r Peso i57r 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: Sever & Water Contractor: Phone: (NOTE: Plans thq ftrfonnatfon. CALL BEFO - before you YOU 1319. Can Gopher State One Call at (661) 4640002 for protection against underground utility damage. Call 46 hours to dig to receive locates of underground utilities. rvww.aosharotpteonaralt.orq 1 hereby acknowledge that this information is complete and accurate; that the work will be in =romance with the ordinances and codes of the City of Gegen; that 1 undwat end this Is not a comb. but only an oopllcadon for a permit, and work is not to sten 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 authorf¢ed by a building permit issued In accordance with the Minnesota Stale BuildittLCode must be completed within 180 days of permit Issuance. x aid2.2_if Applicant Printed Name 90/50 39 d x. Applicant's Signahlro 7 7 ., Page 1 of 3 1NIt7W 1X3 I3S L9Z9T98ZT9 SG:TT bTOZ/bZ/60