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4709 Grenada Pt - S&W 91385Date: 9/30)0 7 Fee: $50.50 ity Sewer City Water Repair Disconnect Description Of Work: 1 ��Y \\/\'Q____ Street Address for Proposed Work f1) 6'\ btAlk_. OWNER Name: Phone: Address City Zip: C1 Applicant is: Owner Contractor Licensed Pipelayer Master Plumber y Property Owner Name: k e---\ 0 Phone: V5/ 952' 15 b Address City /Zip: 4 24CGIA4e,e c r )D Pipelayer Training Certification Card or Master Plumber License I acknowledge that the information of the City of Eagan and the not to art without a p rmit. M. ea, Aneir-,__. is complete and accurate and that the work will be in •nformance with the ordinances and codes State of MN Statutes. I understand this is not a permit b only Ai ap• ication for a permit, and work is j Applicant (Print Name) Appl can Signature City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 egg± 0 Permit v`' 2 5-6_ Permit Fee: -CC) Date Received: g 7) Staff: 2009 SEWER AND WATER REPAIR DISCONNECT PERMIT