1981 Gold Tr CITY OF, EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:.
Eago 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: r)
Ordinances. Misc. Charges: : 1`b50
B /1114d./1114d.2% Total:
Y 7 7 -49 Z Date Paid:
u
Date of Insp.• tut.
CITY OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road 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:
B y Misc. Charges:
Dote of Insp.: Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
F-----------------
I For Office Use 1
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"bilof of Eagain I Permit I
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I Permit Fee: ~
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 u 1 Staff. I
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION at $ r A- qp S
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Date: _1 Site Address: . Unit
Name: { joL,,e. G4,✓1AX)A elf Phone: ~r~3 0 ' (rDD I
Resident! L VIIILQJ
Owner Address / City / Zip: 13 ~c~D ~vv+ A aA IVIPJ fug `19
Applicant is: Owner Contractor _
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Type of Work Description of work: kptlaa:e
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Construction Coyyst:'' n Multi-Family Building: (Yes /No Company: , R(AYN f3VS Contact: &,L
Contractor Address: City: S'Ulr~
Stater 1~ t1 v Zip: Phone: nl - lD
License Q -b LP 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:
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.aonherstateonecall.ora
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.
X_ 11A,61k
Applicant's Printed Name Applicant's Signature
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