1991 Gold Tr CITY Of EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Ewan, 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:
/ Date Paid:
Date
Date of Insp. • ( nsp.:
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:
By _ __ Misc. Charges:
Dote of Insp.: Total:
Insp.: _ _ Date Paid: —
Use BLUE or BLACK Ink
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I
For Office Use
ing Permit#:
City of Ea Rd~ ; ~
Permit Fee. I
3830 Pilot Knob Road I 1
Eagan MN 55122 ; Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
1 I
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION Qq,
Date: Site Addresv- Unit
Name: C?i t & Phone: ~ ~
Resident/ r
Owner Address / City /Zip:
Applicant is: Owner contractor
Type of Work Description of work:
Construction Cost: Multi-Family Building Ye / No )
Company: h ? L - V . # Contact:
Address: 1~4~lG L t t! A.~^c City: 1
Contractor
1 r r
State: Gil ~ L Zip: Phone: ` 7? - , O 1
License 0._.. rj 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.aopherstateonecall.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 St Buil i g o e mu` be completed within 180
days o ermit issuan 'i,
X ' l l x
_
Applicant's inted Name Ap lica i tare
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