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4227 South Robert Tr CITY OF EAGAN Remarks Addition Auditor's Subdivision 1142 Lot Blk Parcel 10 03900 020 04 OwnerPJIAd 1 B9164v Sveet 'l!1".2J S. Robert Trail State Eagan, MN 55123 Improvemenc Da[e Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK SEWER LATERAL WATERMAIN WATER LATEfiAL WATER AREA STORM SEW TRK STORMSEW LAT WFB & GUTTER SIDEWALK STREET LIGHT WATEq CONN. BUILOING PER. SAC PARK 4111/1' City of Eaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: '-/-13 17 J 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: �� 7 /3 Site Address: , 7 S t C Er l I 1 : Unit #: S . Re ide t/ ner Name: �fx %idr i2.JS Phone: 657— ��S C�£T ���.-y / Address / City / Zip: %`c.� 5 5 gc di c r j 1 r , , `Q cp q ri �/rr _ —57--CA-773 Applicant is: Owner l< Contractor • Of Or Description of work:: Do 1-10. Construction Cosh dCCO. co Multi -Family Building: (Yes / No ''. Contra for „,. Company: Contact: Address: City: State: Zip: Phone: License #: Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING In the last 12 months, has the City of Eagan issued a permit for a similar Yes No If yes, date and address of master plan: A NEW BUILDING plan based on a master plan? Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: NOTE Plans and supportin cu � g eis t of our emit are con eubl� r io P rtiaia o heinformation ay c/as n need a h pt I f.r o Prov de otic' easo s w% ermr the C� t• nittafe, #haf hey ate frac a se+cre CALL BEFORE YOU DIG. Call 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.orq 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 plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x /CC(/' fl dt Applican ' Printed Name