1965 Gold Tr CITY OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eaten, 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 e Paid:
Date of Insp.: I nsp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3795. Pilot Knob Rood PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: _ No. of Units:
Owner:
Address:
- - - - -- - - - - -- - - - -- Site Address:
Plumber:
1 agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.: Total:
lnsp.:— _ Date Paid:
Use BLUE or BLACK Ink
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For Office Use
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~ Permit I
City of EaKd Permit Fee: ~'as I
3830 Pilot Knob Road I 2 I
Eagan MN 55122 Date Received: I ~3 IJ
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff: I
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
6111
. Name: Phone: 6s
Resident/
Owner Address / City / Zip: Ik- 1q65 ~ to a
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Applicant is: Owner K. Contractor
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Description of work: Qp,~- V'D-r~~~~`2
Type of Work
Construction Cost: (dj 00L/) Multi-Family Building: (Yes / No
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Company: Pak o tiyy" uc ~Y~ Contact:
Address: ZO R(3 R& h u'E City: ~ U~~~
Contractor
State: MW Zip: ~W61 M Phone: O
License 5C.6gx-2_7 (n 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 _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
m..,.. .
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 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.aopherstateonecall.orp
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 permit issuance.
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Applicant's Printed Name App ' n Sig
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