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1645 Donald Ave
City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 r FCC;:= 2009 RESIDENTIAL BUILDING PERMIT APPLICATION Use BLUE or BLACK Ink Permit GI Permit Fee: C M V� Date Received: Staff: Date: 1 1 Site Address: 4 L1 5 h/4. I/-4 1 `V A 1M bC c� Il.- T LVIc f�Gi Slays Sffl��fG�9 Suite Tenant: RESIDENT OWNER TYPE OF WORK CONTRACTOR Name: 1� 4 I 'z'(--y Phone: Address City Zip: o y is i 'v, 1 Applicant is: Owner Contractor 1, ell 0 w 15''l 45' Mk' Fr Description of work: c Construction Cost: Multi- Family Building: (Yes No Name: 1OL- S c,l ji C ,4- N c License Address: r L t fr ICio In C I -(2 !'t City: A- lo r (-A VA f et State: Y J Zip: 45 Z Phone: f C Z C I 1 2- a 5 `3eontact 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: Mechanical Contractor: Phone: Sewer Water Contractor: Phone: NO Plans and supporting documents that.you submit are c ©nsidered,to be public information" Portions o the information may d c lassified as non public if you provide =spec reasons that would permit the City to conclude that they are trade ,secre CALL BEFORE YOU DIG. CaII 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.gopherstateonecall.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 lans. x Applicant's Printed Name x Applicant's Signature Page 1 of 3 CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road P. O. Box 21199 PERMIT NO.• Eagan, MN 55121 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber: _ Meter No.: Connection Charge: Size: Account Deposit: Reader No.• Permit Fee: I agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: " f _ Total: B y Date Paid: Date of Ins CITY OF EAGAN SEWER SERVICE PERMIT 3B30 Piigt Knob Road P. O. Box 21199 PERMIT NO.• Eagan, MN 55121 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: Date of Insp.• Total: Insp.• Date Paid: