3906 Cedarvale Dr
Z r, -C9 t CITY OF EAGAN
i t 3795 Pilot Knob Rood Eagan, MN 55122 N2 6489
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used for Est. Value Date , 19
Site Address 0 o CQClCkf Uc Ar ❑ Occupancy
Lot Black Sec/Sub. Alter ❑ Zoning
Parcel # Repair ❑ Fire Zone
Enlarge ❑ Type of Const.
99 W Name Move ❑ # Stories
Z Address Demolish ❑ Front ft.
3
Grade ❑ Depth ft.
G Phone
W Name Approvals Fees
0
0~ Address Assessment Permit
~ Ci Phone Water & Sew. Surcharge
Police Plan check
FZ
01 Name Fire SAC
uG Address Eng. Water Conn.
<W City Phone Planner Water Meter
Council Road Unit
I hereby acknowledge that I have read this application and state that Bldg. Off.
the information is correct and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances. APC Total
Signature of Permittee
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
pwMM # Date heed Pendlhe
Plumbing
Mechanical :z 3
INSPECTIONS DATE INSP.
Rough-In Final
Footings Date Insp. Date Insp.
Foundation _ Plumbing
Frame/ins. Mechanical
Final
Remarks:
CITY OF EAGAN
3795 Pilot Knob Road
No. Eo"n, Minnesota 55122 INSPECTOR NOTIFICATION
Phone: 454-8100 REQUIRED BY LAW
PERMIT FOR ALL INSPECTIONS
Dote: 4f 1
Receipt No.:
Single
i `r rte'
Site Address: Residential
'
Lot Block Sub/Sec. Multi Res., Comm./Ind.
Name i, New/Alter./Repair L
Address Cost of Installation
C City Phone: Permit Fee
Nome Surcharge
Address
City Phone: Total
This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Building Official
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: !
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS:' 041) I f' W'" APPLICANT:
li l 1 ~ n. t
r r,i:':-+11 ! 1~1 1 i ,'t Ilrrti,•ir t r 1 #4
, ~ ~ ,tlt'I f~ i
PERMIT SUBTYPE: TYPE OF WORK:
INSPECTION TYPE DDATE INSPTR. INSPECTION DATE INSPTR.
- -
r
I
Permit No. Permit Holder Date Telephone R
ELECTRIC
PLUMBING
HVAC
Inspection Dab Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST I
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL l~
BSMT R.I.
BSMT FINAL
DECK FTG
I
DECK FINAL
I I
CITY OF EAGAN Remarks
Addition CEDARVALE OFFICE PARK Lot 12 Blk 1 Parcel 10 16850 122 Ol
Owner Jean 9. va=aa" Str a State Eagan, MN 55122
3 rD 1, _ dct~uf l l + a
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1975 294-89 29.9 10 R~t
STREET RESTOR. 197 2.71 54.27 10
GRADING
Rahn Sidewalk 1975 45-54 4-55 10 1
SAN SEW TRUNK 19 assessed der parcel 3257- 1
SEWER LATERAL
WATERMAIN
WATER LATERAL 167 J-5r(z • 26 .WATER AREA 1977 . .3 10
00STORM SEW TRK .0OS 7 3 , 5 1$ -377-57 CEO 159 3
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. ~SSe
BUILDING PER.
SAC Qd 3 _
PARK
This request void
18 months from _ ry~ 2 3
Date of this Request Fire No. 17152
I, as YLicensed Electrical Contractor ❑ Owner, do hereby request inspection of the above electri-
cal wing installed at: fq6 l~ ~i>G(G r cicc Q p
Street Address or Route No.~:iv~'Q - r city
Section Township _ Range County_
Which is occupied by
(Napa of Occupant) Is Is a roughin inspection required on this 'ob? No ❑ Yes Ready Now ❑ Will Call 19
KENBRICK: ELECTRIC ~ x 74 , O
Power Supplier < n rw h r1 -AtidYesS '
Electrical Contractor A PP E~~TAL~ i. . 24 Con actorYLr&ZZ _
Mailing Address GARY l lt' 4312-50206
(Electrical Contractor or owner Making This Installation)
Authorized Signature Phone No.
(Electrical contractor or Owner Making This Installation)
STWE 10 COPY This inspection request will not accepted the
Fit -State Board unless proper inspection fee is enclosed.
nnnnesota ovate aoaro or cnecmcrty
Griggs Midway Bldg. - Room N191 r/ EEI-00001-02
1821 University Ave., St.. Paul, Minn. 55104 - Phone 297.2111 J
CHECK BELOW ORK QLECTRICAL
S REQUEST ION T 17152v/
Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For
Home ❑ ❑ ❑ Range ❑ Temporary Wiring ❑
Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑
Apt. llldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑
Commercial Bldg. ❑ ❑ ❑ Furnace ❑ Silo Unloader ❑
Industrial Bldg. ❑ ❑ ❑ Air Conditioner ❑ Bulk Milk Tank ❑
Farts ❑ ❑ ❑ pLLut / List
Other ❑ ❑ ❑ Hererst Oerers~
COMPUTE INSPECTION FEE BELOW f }i )
Service Entrance Size: # Fee 11 Feeders&Subfeeders: # Fee Circuits: # Fee
0 to 100 Amps. 0 to 30 Amperes 0 to 30 Am eres
101 to 200 Amps. 31 to 100 Am res 31 to 100 Amperes
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Transformers Remote_Control Circ. Partial or other fee
Signs Special Inspection Minimum fee 5.00
Remarks O~ ~j Sq
a l TOTAL E 0 V
I, the Electrical I ~ctot 'y'c rtif that the above inspection has been ma e.
(Rough-in) Date
(Final) Date
This request void ICY -
18 months from
This request void I ZZ - O l C E ~c c u Cam` t 0 r 9 i- f` 1
18 months from _ 1
Date of tJ4is Request r / Fire No. T 17129
1, as VLicensed Electrical Contractor ❑ Owner, do hereby request inspection of the above electri-
cal wiring installed at: ~cjo (y ~r t 2~
Street Address or Route No. Crit~y_ ~
Section Township Range CountyL
Which is occupied by
ame of Occupant)
Is a roughin inspection required on this job? No ❑ Yes ❑ Ready Now ❑ Will Call ❑
rT - j+ qnr ^
Power Supplier Addrpls-
Electrical Contractor n)n~ r T i3 + 1 'VV MT4 `'i i 1 74 Contractor's License No.
tt Ty (comOdny IVaMe)K 0Mailing Address
(Electrical Contractor or Owner Making This Installation)
Authorized Signature Phone No.
fitTE ~s C(ElectGPIrical contractor or Owner Making This Installation)
SUr&`r1 COPY This inspection request will not accepted the
State Board unless proper inspection fee is enclosed.
Minnesota State Board of Electricity
Griggs Midway Bldg. - Room N191 1 EB-00001-02✓
1821 University Ave., St. Paul, Minn. 55104 - Phone 297-2111 W
CHECK BELOW WORK OCO ER TRICAL Y ITHIS REQUEST INSPECTION
a T 17129
Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For
Home ❑ ❑ ❑ Range ❑ Temporary Wiring ❑
Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑
Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑
Commercial Bldg. ❑ ❑ ❑ Fumace ❑ Silo Unloader ❑
Industrial Bldg. ❑ ❑ ❑ Air Conditioner ❑ Bulk Milk Tank ❑
Farm ❑ ❑ ❑ List List
Other ❑ ❑ ❑ Hehers}. Hehers
COMBUTE1NSPEC ION EE E' 1
Service Entrance Sla e_ &Subfeeders: # Fee Circuits: # Fee
0 to 100 Am s _4.10 0 Amperes 0 to 30 Amperes
I0h to 200 Amps. to 100 Amperes 31 to 100 Amperes
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Transformers Remote Control Circ. Partial or other fee
Signs Special Inspection Minimum fee $5.00
Remarks
TOTAL EE ,
1, the Electrical 1 pector, here certify that the above ins ection has een ma
(Rough4n) f _ f
(Final) e~~-r~7
This request void
18 months from
r r,ir
CITY of EAGAN N° 3821
B,/{U,-,ILDING PERMIT
Owner Y .t... .(..(a~.rrl..~..1L/. 3785 Pilot Knob Road
Eagan, Minnesota 55122
Address (present) 7 454.8100
Builder J. r-- J.41 e t? ....~/.1.C..,.............
Dale
Address ?.Or
DESCRIPTION
Slosiesl To Be Used For Front Depth Heigh! Est. Cost Permit Fee Rem rk6
r 2 ~
lo 4/
!P 0 `17r 7 t ids a
LOCATION
Street, Road or other Description of Location Lot slo ~y Addition or Tract U
This permit does not authorise the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. r~
This is to certify, that.. ~!n ................has permission to erect a..&........... P... ! ~--:P................... .upon
the above descriibbee"remise subject to the provisions of all applicable Ordinances for the City Eagan.
P -27 Per .C-/-~"-°
✓ Mayor Buil ng Inspector
MASTER CARD
s 7 0(o C(' C4.4)-U akx P~,, v7
LOCATION
OWNER L. MG/G G lNCi.
STRUCTURE AND ~j
LAND USED AS .f /GB /J~~O .io X Sf0
Issued To
Permit No. Issued Contractor Owner
BUILDING -,1z-xr- MO I gi
PLUMBING 238. l
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING A3 Q 9 >G i y T~~
GAS INSTALLING !
SANITARY SEWER
OTHER
OTHER
Approved
Items (Initial) Date Remarks Distance From Well
FOOTING SEPTIC
FOUNDATION CESSPOOL
FRAMING TILE FIELD FT.
FINAL
ELECTRICAL
DEPTH
HEATING OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING _ Q_ I
WELL
SANITARY SEWER
Violations Noted
on Back
COMMENTS:
CITY OF EAGAN
7 _ 3795 Pilot Knob Rood Eagan, MN 55122 N2 6489
PHONE: 454-8100
BUILDING PERMIT APPLICATION Receipt #oj~
To be used for REZv=Tf~r- OF'FICj~t. value 3,000 Date 1-21 1981
Site Address -3 1(7 (n 1lrv't 'nPn E~rec~ ❑ Occupancy
Lot 12 Black 1 Sec/Sub. CerlarVala Off.Park Alter :KK Zoning
Parcel# ID (z2- 6I Repair ❑ Fire Zone
Paul Hauge Enlarge ❑ Type of Const.
W Name Move ❑ # Stories
z 3908 Highway 13
o Address dri _ Demolish [3 Front ft.
4544224
City g phone Grade ❑ Depth ft.
Approvals Fees
~ Name Al BahT17111
Z< Address 14850 Granada Ave. Assessment Permit 12.00
~F City Apple Valley Phone 432-9700 Water & Sew. Surcharge 1.50
Police Plan check
uw Name
z Fire SAC
Address Eng. Water Conn.
<w C1 ptq~ Planner Water Meter
Council Road Unit
I hereby acknowledge that I have read this application and state that Bldg. Off.
the information is correct and agree to comply with all applicable 13.50
State of Minnesota Statutes and City of Eagan Ordinances. ARC Total
Signature of Permittee
A Building Permit Is issued to: Paul Hauge on the express condition that
all work shall be done in accordance~~th I~ appli ble S/tyre of Minnesota Statutes and City of Eagan Ordinances.
Building Official ,~~o~t /
CITY OF EAGAN Include 2 sets of plans,
~I Y 1 site plan w/elevations &
BUILDING PERMIT APPLICATION 1 set of energy calculations.
Ib Be Used ForP ~Lr Valuation 0 Date
Site Address `Y - "rciOC~ C:CrOr~ ~e`FICE USE ONLY
Lot 12 Block 1 Sec./Sub. Cedarvale Offie±rect Occupancy
Parcel Park Alter Zoning
Repair Fire Zone
Owner: C~l~ Cj (2 Enlarge _ Type of Cont.
Move # Stories
Address: - Demolish _ Front ft.
City/Zip Code P Grade Depth ft.
Phone L y- Y-,:) 3 u
APPROVALS FEES
Contractor: t L a) a A r8 /Y i Assessments Permit 445,6
Address: 14850 Granada Avenue Taater/Sewer Surcharge 1.56
Police Plan Check
City/Zip Code: Apple Valley, MN 55124 Fire SAG
Phone 432-9700 Eng- Water Conn.
Planner Water Meter
Arch./Eng.: n/ Council Road Unit
Bldg. Off.
Address: APC
City/Zip Code:
Phone =AL
i
I
i^dows
S7aUsr
I
raw
~~LLS
pivL~
Pro F,
g7-r- c p s
ro ~Oc~rn
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%v ins ~~vcLQ d an'
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.l } ss 0 C,
PERMIT 'Cosoaay
CITY OF EAGAN 1114 Os
3830 Pilot Knob Road PERMIT TYPE: BUILDING
Eagan, Minnesota 55122-1897 Permit Number: 0 2 6 7 6 6
(612) 681-4675 Date Issued: 11/27/95
SITE ADDRESS:
3906 CEDARVALE OR
LOT: 122 BLOCK: 1
CEDARVALE OFFICE PARK
P.I.N.: 10-16850-122-01
DESCRIPTION:
(WINDOWS)
Bu'lldinglPermit Type COMM./IND. MISC.
Building Wo'Xk Type ALTERATION
ii
1
/ _ ji tp iF t l
REMARKS:
FEE SUMMARY:
VALUATION $5,000
Base Fee $99.75
Surcharge $2.50
Total Fee $102.25
CONTRACTOR: - Applicant - OWNER:
PROTECTIVE HOME COVERING 28840123 TRANS INT'L GROUP INC
9929 PLEASANT AVE S 4164 3906 CEDARVALE OR
BLOOMINGTON MN 55420 EAGAN MN
(612) 884-0123
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all applicable State of Mn.
Statutes and City of Eagan Ordinances.
~U1B~ MAT r~ 1
APPLICANT /PERMI ESIGNATURE ~B :SIG- A~~~E r
CITY OF EAGAN 4 o
164C ~ 1995 BUILDING PERMIT APPLICATION (COMMERCIAL)
681-4675
The following are required with appropriate certification for all 11" construction:
• 2 each: architectural plans; mech. d slae. plans; fire sprinkler plans; structural plans; site plans; landscaping plans; greding/dralnage/srosion control
plan; utility plan
• 1 each: set of specifications; set of energy calculations; electrical power & lighting form; Special Inspections & Testing Schedule
• Letter from MCNVS (phone #222-8423) indicating SAC determination
• Code analysis indicating: Codes used; occupancy classifications; setbacks; maximum allowable area as per Building and City Codes along with sq.
ft. per floor, type of construction (synopsis of construction components) & any occupancy or area separation walls;
occupancy bads; exit synopsis with a diagram indicating exiting loads from each room or area, travel paths & all rated
corridors; plumbing fudures; and parking.
DATE: -.,)7- EL WORK TYPE:_ NEW REMODEL
DESCRIPTION OF WORK: V1 AI ~4 19{Gi46elA Pn &t,)/hZT404U S
CONSTRUCTION COST: ~b TENANT NAME: A ✓rta~tvK l~r~~~r .iNC.
SITE ADDRESS: 3~ b ` ~'CXcv'yu t~G . CTS a "c /f y r .
LOT-UL BLOCK SUBD. l-Q.4'.V7.fl;L^}~r11Q~, P.I.D.#
~
PROPERTY Name: Phone
OWNER u°.
Street Address,
City: State: Zip:
CONTRACTOR Company: LA-eJUVC 11i1OM-e fftuertnn v~c_ Phone#: by'o(a
Street Address,RW P (C Q.salk-~ 4-e 1*'W y
City:-~>(01~4Mt-tAc--- , 6~- Zip: ~aO
13
ARCHITECT/ Company: Phone #
ENGINEER
Name: Registration #
Street Address-
City: State: Zip:
Sewer & water licensed plumber:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
❑ 01 Foundation-19 Comm./Ind. Misc. ❑ 21 Miscellaneous
❑ 18 Comm./Ind. ❑ 20 Public Facility
WORK TYPE
0 31 New to 43 Alterations ❑ 35 Tenant Finish
❑ 32 Addition ❑ 34 Repair ❑ 37 Demolition
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MCIWS System
(Allowable) First Floor sq. ft. City Water
UBC Occupancy sq, ft. Fire Sprinklered
Zoning sq. ft. Census Code y37
# of Stories sq. ft. SAC Code
Length sq. ft. Census Bldg. I
Depth Footprint sq. ft. Census, Unit
APPROVALS
Planning Building Engineering Variance
Permit Fee -75- Valuation: $ S 6?-O~
Surcharge 21 sv
Plan Review
MCMS SAC
City SAC
Water Conn.
S/W Permit
S/W Surcharge
Treatment Pl.
Road Unit
Park Ded.
Trails Ded.
Water Qua[.
Other
Copies
Total:
% SAC
SAC Units
Meter Size
INC.
REALTORS
3908 SIBLEY MEMORIAL HIGHWAY ST. PAUL, MINN. 55122
PHONE 464-1600
1•,
~cw~er 13, 1v74 19~k r
C~' v
i-
,y ~
S ~
oaert piers
;;dt,;,;.a „lessor
Dakota Loontv Leurthouse
,innesota 55033
Dear 4r. Tiers:
:.is will confirm our telephone conversation
regw.•ritinq that YOU c hr:uir:e tax parcel:, d-385 D, d-386o,
and d-3587 into a single tax parcel.
i:•1es parcils cover Lots 1, z,, and 3, Cederv
Office ea on -?hicn we have constructed one building the
valu-stion oi' is now on tax parcel d-3366.
Vary truly yoArs.
J. E. PARRANIU loo.
J. E. Parranto
Ji.P/pak
CL:~'I-iS. Ann Gores, Eagan City Hall
December 11, 1974
Alan R. Paymar
3906 Sibley Mom Hwy
Eagan, MM 55122
Dear Mr. Par=:
We have discovered in checking our records that an error *as made in the
posting of your 1972 Water Area Assessment.
The total amau►t of the assessment was paid in August.Of 1971 and the 1972,
1973, and 1974 installments in the amount of $18.31 is now being rebated
to you.
We are sorry for any inconvenience this error may have caused you.
If you have aKy questions concerning this matter please feel free to
contact me at the City Hall.
SPECIAL ASSES34ENT DEPARTMENT
Sincerely,
Ann Goers
Assessment Clerk
City of Eagan
Aop2cs5 C N~ caE
1
Z•19~8~
• GXtST!_n~y PCORESS __'.~0$__SLExL-~f _ MEMO¢.rAL. N~[aN~/~`~_
F,tEW __APoQESS 39o(c.---C E eyA~ _D2~VE
r-----------------
For Office Use
- r I
City of Ea ll~ I Permit
I Permit Fee: 1
3830 Pilot Knob Road I 1
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 I staff:
2009 SEWER AND WATER REPAIR / DISCONNECT PERMIT
Date: /7 Vi / Fee: $50.50
City Sewer City Water Repair Disconnect
Description Of Work: Ri t cc (2
Street Address for Proposed Work -'1aAj~"r A C b l by
OWNER Name: \ Lb Phone:
Address / City / Zip:
Applicant is: Owner Contractor
Licensed Pipelayer* Master Plumber Property Owner
Name: 01/1 Li~ ~CKL lit ~1At 5~2 Phones: C lc~ - -27- ` -7
Address / City / Zip:
Pipelayer Training Certification Card r9 1s7 &v or Master Plumber License
I acknowledge that the information is complete and accurate and that the work will be in conformance with the ordinances and codes
of the City of Eagan and the State of MN Statutes. I understand this is not a permit, but only an application for a permit, and work is
not to start without a permit.
Applicant (Print Name) Applicants Signature
I
' M r
- - - - - - - - - - - -
ForOf -fice
-72
City of Eajan
Perms Fee I
3830 Pilot Knob Road t i
Eagan MN 55122 f Cate Reoeivea: j
Phone: (651) 675.5676 t
Fax: (651) 675-6694 stair:
- - -
2009 COMMERCIAL BUILDING PERMIT APPLICATION
Date: site Address: 3 9 O 6 Cedar vale & i ve
Tenant Name: (Tenant is: New i E)isting) Suite
Former Tenant:
PROPERTY OWNER Name: Da ko fa Coan 6e G D 4 Phone: 651 r 6"75 - 4Y6 7
Address / City / Zip: 1-1-2g -rd W n e e4 fie D r r V e
Applicant is: Owner --X- Contractor
TYPE OF WORK Descriptlonofwork: ,pv~ lorin~ ~elYi4~J~7f id ft
Construction Cost
CONTRACTOR Name: W r ktm h qdl@ 111df~x y h G, License Address: 136,7 36,50 GOtII? i R04rd /-/,d
city. Co /d j n 4 /state: MY ZiD: 513 Z Z
Phone: !Z f _ y46- 7, 23) Contact Person: y 811
ARCHITECT / Name: Me lkSa 74i0horn Registration
ENGINEER
Address:
City: State: Zip:
Phone: Contact Person:
licensed plumber installing new sewer/water service: Phone
NOTE. Plans and suppor# ng documents that you submit am considered to be public frdbmu tian. Portions of
the mformation may be classified as narNpublic if you provide specific reasons that would permit the City to
conclude that the are trade secrets
1 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.
,Don Witkenhavser X V6 n-
Applicant's Printed Name Appticanrs Signature
Page 1 of 3
nF EAGAN WATER SERVICE PERMIT
,.35 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units: _
Owner:
Address: Feb
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
I agree to comply with the Village of Eagan Surcharge:
Ordinances. Misc. Charges: _
Total:
BY Date Paid:
Date of Insp.: " 'Insp.:
VILLAGE. GY EAGAN SEWER SERVICE PERMIT
PERMIT NO.:
3795 Pilot Knob Road
Eagan, MN 55122 DATE:
No. of Units:
Zoning:
Owner:
Address:
Site Address:
Plumber:
I agree to comply with the Village of Eagan Connection Charge:
Account Deposit:
Ordinances.
Permit Fee:
Surcharge:
jj -~---misc. Charges:
By:
Total:
Date of Insp.: Date Paid:
Insp.: