1955 Gold Tr CITY OF EAGAN WATER SERVICE PERMIT
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:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
/C r 711.-) Date Paid:
Date of Insp.: Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3795 Knob Rood PERMIT NO.:
E4an, MN 55122 DATE:
Zoning: No. of Units:
Owner: - --
Address:
Site Address:
Plumber:
I agree to comply with the City of Eagan Connection Charge: _
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.• Total:
tnsp.• Date Paid:
Use BLUE or BLACK Ink
r
For Office Use l I
; Permit
City of Eap
I Permit Fee:
3830 Pilot Knob Road 1 7 1
Eagan MN 55122 ; Date Received: 3 I
Phone: (651) 675-5675 Ir I
Fax: (651) 675-5694 I Staff: ) I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 0 /12 2 3 Site Address: 1 s 3 l ~s~ ~a icy 1 v &oe. c* Unit
Name: ~~iq - s41o r+~tO &l Phone: 6.5'1- .39? -S''7
I Resident/ I
I Owner Address / City / Zip: /.-q' 7 2 EG--7/,Q /,3/c, 64- !~/c
Applicant is: _X Owner Contractor
Description of work:42 do ' ~n ~w s S/
dr-
of Work '
Pe
Construction Cost: o Multi-Family Building: (Yes / No )
' Company: Contact:
i
Contractor Address: City:
State: Zip: Phone:
j License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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 _KNo 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 permit the City to
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.gopherstateonecall.org
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 Building Code must be completed within 180
days of t issuance.
x - dL x o
Ap ant's Printed Name App icant's Signature
Page
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