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
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