1250 Dunberry Lane Bf City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 9 r 0 Site Address: g 52 rt G 4 -e G?O1
y
Suite
Tenant: f- e- C wo '"d
r
Use BLUE or BLACK Ink
Permit l
Permit Fee:
Date Received:
Staff:
RESIDENT OWNER
TYPE OF WORK
CONTRACTOR
Name: A-R k i y Gd L..Q(t I /Act/ Phone: 657- ?v5" (ref)Z
Address City Zip: y 6.3 G k et, (0 &a-I/a-14
Applicant is: Owner Contractor
Description of work: Puf y1 e w W 1i► do ws r4 i djky c>14 t aud
Construction Cost: 2.. 020 4-0 0 00 Multi- Family Building: (Yes V No
Name: J e License
Address:
City: State: Zip:
Phone: Contact Person:
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:
Phone:
Sewer Water Contractor: Phone:
Mechanical Contractor:
NOTE: Plans and supporting documents that you submit are considered to be public information Portions o
the information may be classified as non public if you provide specific reasons that would em he City tc
conclude that they are trade secrets,
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 p
x ett'h Pe/7? CI, x
Applicant's Printed Name Applicant's Signature
Page 1 of 3
CITY Of EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: _ No. of Units:
Owner:
Address:
Site Address: 13 ___
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 or ®r Date Paid:
"
Date of Insp.: o' / Insp.:
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: —
I agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: —__—
Permit Fee:
Surcharge: _
By —__ Misc. Charges:
Date of Insp.• Total:
Insp.: _ Dote Paid: _
34 +tpo'
•
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