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