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