Loading...
3411 Highlander DrJun. 8. 2011 2:42PM SELA ROOFING *City oi6api 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 No.6530 P. 2 Use BLUE or BLACK Ink Permit # 9Z s Permit Fee: �_339 4,9 Date Received: Staff: / j2011 RESIDENTIAL BUILDING PERMIT ijAPPLICATIO Y L Site Address: _ 1( 301 t { lni #' RESIDENT 1 OWNER Name: 166 QW)f,/ .gone%5a—g —567 r' Address I City t Zip: CJ`Io I (5467D M 511,1 i ) t -Applicant is: Owner /\ Contractor TYPE OF WORK Description of work4 1!A ' ! /"moi.1101 ditLIL._,� I. gir Construction Cost O4 . 0� /�V Multi -Family Building: (Yes / No ) CONTRACTOR Company: acorl N 67 Contact: 6444- tC, V ilay Address: IO6 t OL W City: L . l Ill 1' L: State: rtC.9 Zip; 554 1 Phone: Le/(2---62,96-4 License #: OD `0 60 Lead Certificate #: itiki ^ 6 5. V,3`L - i If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, Yes No If COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan issued a permit for a similar plan based on a master plan? yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: NOTE: Prins and supporting.documents that you. submit are considered: to be public inforrnation. Portions of the information may beclassified as non-public if you provide specific reasons that would permit the Cityto conclude that they are trade secrets. 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.aooherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in oonformance Eagan; that I understand this is not a permit, but only an application for a permit, and work is riot t0 Start accordance with the approved plan in the case of work which requires a review and approv— plans. phcanrs Signature (SAM Uk-AAJ 10_10 Applicant's Printed Name the ordinances and codes of the City of r flout a per i t; that the work wilt be in 7 Page 1 of 3 DEC -29-2009 12:17 From:SAMSUNG City of Earn 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 To:6516755694 Page:2'2 Use BLUE or BLACK Ink For ^ffceir as Permit Permit Fee: g o ` (/ t/ Date Received; Staff: 20.099 RESIDENTIAL BUILDING PERMIT APPLICATION Date: /2- ^c70.-�vv / Site Address: 3`1 i 1 -rt be-fi eViehA �c- /✓£� i Tenant J Suite #: ^1 /A RESIDENT / OWNER Name: MC -el 6 iE Phone: 67501 - e7;'- 6 4/� 7 ) Address / City / Zip: 3Z% 1) I -1-t gh 1.f1 rJA UL ..t(Z 11 L. Applicant is: Owner X_ Contractor C - ,(4 0 L2 . TYPE OF WORK Description of work: 4714ee Ai / -• - ,JQ A 1-r'£-4-• of U IE,J a Ic Construction Cost � e' Multi -Family Building: (Yes X ! NO ) CONTRACTOR Name: A t.Ls%ali- G;.,JSilzarfr69,1 OA nl PMtJfLicense #: Z.O 3 i S -75- tsAddress: Address:5 -It -IS /n4iNuis'Tre_:At__ Sr .. .iTri i0 City: /1/10./1/10. Pte aa...,, ;->_.) State: %n/+/ Zip: 553j $ �/ Phone: 95 "-40- ' 717/-/ Contact Person: -fit * A Lt-c--,--04-")COMPLETE In the last 12 months, has Yes No If yes, THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING the City of Eagan issued a permit for a similar plan based on a master plan? date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered ftp. be public informations Portions of" the information may be classified as non-public if' you provide specific reasons that would permit the City to conclude that they are trade secrets. .. 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.nopherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances a 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 sta witt 5 : • : at a work will be in accordance with the approved plan in the case of work which requires a review and approval pf plans_ x,�.. f�i-i%E.wt Applicant's Printed Name Applicant's Signature Page 1 of 3 Clly of Eaali Date: /0 Site Address: x J'e (`e/6'7 Applicant's Printed Name 3V)) 1 lot/yin 2009 Fo Use BLUE or BLACK Ink Permit 1 1 Permit Fee: 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 2009 RESIDENTIAL BUILDING PERMIT APPLICATION C \1kkc( /6--/(7 Date Received: V 1 Staff: Tenant: Suite RESIDENT OWNER TYPE OF WORK CONTRACTOR Name: i ke i1 e /6,, Address City Zip: Applicant is: )(Owner Contractor Phone: 73 a9a Description of work: Construction Co a c- Ac_ce 50 Ad t5i) eel- toe K se.i, Multi Family Building: (Yes No 0000 License Name: Address: City: State: Zip: Phone: Contact 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: Phone: Sewer Water Contractor: NOTE Plans and upportin docum that you submit are consi th e informati n may be classified as non public IT you provide speci conclud that they ,ire trade secr h e C f o be public informati so ns that would per fiS 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.gooherstateonecall.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. nt's Signature Page 1 of 3 SUB TYPES Foundation Single Family Multi 01 of Plex Accessory Building WORK TYPES New Interior Improvement Addition Move Building x Alteration Fire Repair Replace Repair Retaining Wall DESCRIPTION Valuation Plan Review (25 100 Census Code of Units of Buildings Type of Construction REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: Ice Water _Final )e Framing Fireplace: Rough In Air Test _Final •i< Insulation Meter Size: Reviewed By: RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit Surcharge Treatment Plant Copies Fireplace Garage Deck Lower Level ae, L 0 L44 TOTAL DO NOT WRITE BELOW THIS LINE 7Z Storm Damage Exterior Alteration (Single Family) Exterior Alteration (Multi) Pool Miscellaneous Porch (3- Season) Porch (4- Season) Porch (Screen /Gazebo /Pergola) Occupancy Code Edition Zoning Stories Square Feet Length WMtI� iev Siding Reroof Windows Egress Window m� of S 7t prrf 1'7G CL IC, V OO Demolish Building* Demolish Interior Demolish Foundation Water Damage *Demolition of entire building give PCA handout to applicant MCES System SAC Units City Water Booster Pump PRV **Sprinklers Sheetrock y Final C.O. Required Final No C.O. Required 0 9 00 HVAC Other: Pool: _Footings _Air /Gas Tests _Final Siding: _Stucco Lath _Stone Lath _Brick Windows Retaining Wall: Footings Backfill Final Radon Control Erosion Control Building Inspector Page 2of3 guu. cross Amount Due To Seller 101. Contract sales .rice 43,931.00 401. Contract sales rice 43,931.00 102. Personal .ro.e 502. Settlement cha es to seller line 1400 503. Exlstin a loan s taken sub ect to 504. Pa off of first mort: a e loan 402. Personal .ro.ert 205. 103. Settlement cha !e to borrowe line 1400 471.00 403. 206. certlfed assessment 104. .rorated assoc dues 9/24/2009 to 10/1/2009 58.68 404..rorated assoc dues 9/24/2009 to 10/1/2009 58.68 105. Ad ustments For Items Paid B Seller In Advance 106. Clt /Town taxes 507. 405. Ad ustments For Items Paid B Seller In Advance 406. Clt /Town taxes 208. 107. Count taxes 508. 407. Coun taxes 209. Ad ustments For Items Un ald B Seller 210. CI /Town taxes 211. Coun taxes 7/1/2009 to 9/24/2009 212. Assessments 108. Assessments 509. Ad ustments For Items Un aid B Seller 510. Clt /Town taxes 511. Count taxes 7/1/2009 to 9/24/2009 512. Assessments 408. Assessments 213. 109. 513. 409. 214. 110. 410. 111. 411. 112. 516. 412. 113. 517. 413. 218. 114. 518. 414. 219. 115. 519. 415. 220, Total Paid B /For Borrower 116. 418. ,q ROD A., 117. 417. 118. 418. 119. 419. 120. Gross Amount Due From Borrower 44 460.88 420. Gross Amount Due To Seller da ONO RR 201. De•oslt or eamest mone 501. Earnest mone 202. Princl.al amount of new loan for 203. Exlstin a loan s taken sub ect to 204. earnest mono 2 000.00 502. Settlement cha es to seller line 1400 503. Exlstin a loan s taken sub ect to 504. Pa off of first mort: a e loan 13 048.04 205. 505. Pa off of second morte a e loan 206. certlfed assessment 388.23 506. certifed assessment 388.23 207. A. ent credit for title oil 180.00 507. 208. 508. 209. Ad ustments For Items Un ald B Seller 210. CI /Town taxes 211. Coun taxes 7/1/2009 to 9/24/2009 212. Assessments 251.86 509. Ad ustments For Items Un aid B Seller 510. Clt /Town taxes 511. Count taxes 7/1/2009 to 9/24/2009 512. Assessments 251.88 213. 513. 214. 514. 215. 515. 218. 516. 217. 517. 218. 518. 219. 519. 220, Total Paid B /For Borrower 2 820.09 520. Total Reduction Amount Due Seller ,q ROD A., A. Settlement Statement FINAL. B. Type Of Loan r FHA 2 E FmHA 3 E jCarv.unlne 6. File Number. 920682 Kristy Larson 7. Loan Number. E VA 5 L C onv.In C. Note: This form Is furnished to give you a statement of actual settlement costs. Amounts pald to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for Informational purposes and are not Included In the totals. D. Name Address Of Borrower. Michael A. Overby 3411 Highlander Drive Eagan, MN 55122 -1309 E. Name Address Of Seller. Endure Financial Federal Credit Union f /k/a Honeywell Federal Credit Union 820 Lilaa Drive Minneapolis, MN 55422 H. Settlement Agent Edina Realty Title, Inc. Place Of Settlement 1519 Central Parkway Ste 100 Eagan, MN 55121 IVFw QVvAi,_& t. 0. Property Location: 3411 Highlander Drive Eagan, MN 55122 -1309 Dakota 10-73003-060-01 Lot 6, Block 1, Surrey Heights 4th Addition J. Summary Of Borrower's Transaction 100. Gross Amount Du U.S. Department of Housing and Urban Development K. Summary Of Seller's Transaction F. Name Address Or Lender: OMB Approved No. 2502.0205 8. Mortgage ineumnce Case Number. Settlement Dale: 09/24/2009 Prorallon Date: Funding Date: 09/24/2009 Amount s Pald y Or I n Be Of Borrower 500. Reductions In Amount Due To Se 300 Caah At Settlement From Borrower 301. Gross amount due from borrower(Ilne 120) 302. Less amounts pald by/for borrower(Ilne 220) 44,460.68 2,820.09 41,040.89 601. Gross amount due to selier(line 420) 602. Less reductions In amount due seiler(Ilne 520) 603. Cash ri From Seller 303. Cash Previous editions are obsolete From t To Borrower Page 1 of 3 800. Cash At Settlement To /From Seller Created by Kristy Larson on 09/24/2009 at 3:15 :29 PM 43,989.68 13,688.13 30,301.55 HUD-1 Settlement Statement Certification Title Company, In its capacity as Escrow Agent, is and has been authorized to deposit all funds It receives In this transaction in any financial institution, whether affiliated or not. Such flnanclal Institution may provide Title Company computer accounting and audit services directly or through a separate entity, which, if affiliated with Title Company, may charge the flnanclal institution reasonable and proper compensation therefore, and retain any profits there from. Any escrow fees paid by any party Involved in this transaction shall only be for check writing and input to the computers, but not for aforesaid accounting and audit services. Title Company shall not be liable for any Interest or other charges on the earnest money In flnanclal institutions with which Title Company has or may have other banking relationships and further consent to the retention by Title Company and /or its affiliates of any and all benefits (including advantageous Interest rates on loans) Title Company and /or Its affiliates may receive from such flnanclal institutions by reason of their maintenance of said escrow accounts. The parties have read the above sentences, recognize that the recitations herein are material, agree to same, and recognize Title Company is relying on the same. I have carefully reviewed the HUD -1 Settlement Statement and to the best of my knowledge and belief, It Is a true and accurate statement of all receipts and disbursements made on my account or by me In this transaction. 1 further certify that I have received a copy of the HUD -1 Settlement Statement. Buyers Signatures: Michael A. Overby Settlement Agent: Previous editions are obsolete Sellers Signatures: Endure Financial Federal Credit Union f /Wa Honeywell Federal Credit Union John Ferstl, Vice President Sales Date: /-L-ii/cp Edina Realty 1tle, Inc. WARNING:It is a crime to knowingly ma -false statements o Unit= t s on this or any form. Penalties upon conviction can Include a fine and Imprisonment. For details see: Title 18 U.S. 615119 Seetion4001. -an. action 1010. Page 3 of 3 Created by Kristy Larson on 09/24/2009 at 3:15 :29 PM Escrow 920682 Form No. 7 -M WARRANTY DEED Corporation, Partnership or Limited Liability Company to Individual(s) STATE DEED TAX DUE HEREON: Date: 3 Z® o FOR VALUABLE CONSIDERATION, Endure Financial Federal Credit Union f /k /a Honeywell Federal Credit Union a federal credit union under the laws of Grantor, hereby conveys and warrants to Michael A. Overby, Grantee(s), real property in Dakota County, Minnesota, described as follows: SEE ATTACHED EXHIBIT A together with all hereditaments and appurtenances belonging thereto, subject to the following exceptions: easements, covenants and restrictions of record. Chox if applicable: he Seller certifies that the seller does not know of any wells on the described property. A well disclosure certificate accompanies this document. I am familiar with the property described in this instrument and I certify that the status and number of wells on the described real property have not changed since the last previously filed well disclosure certificate. Affix Deed Tax Stamp Here STATE OF MINNESOTA COUNTY OF tkt a Pi SS. NOTARIAL STAMP OR SEAL (OR OTHER TITLE OR RANK): JEFFREY D SMRCKA NOTARY PUBLIC MINNESOTA MY COMMISSION EXPIRES 1414010 THIS INSTRUMENT WAS DRAFTED BY (NAME AND ADDRESS): Edina Realty Title 6800 France Ave. South Edina, MN 55435 End inanci. ederal Howl Fe;�I Cr n Ferstl, Vice President Sales This instrument was acknowledged before me on C 1( by Johns Ferstl Vice President of sales for Endura Financial Federal Credit Union f /k/a Honeywell Federal Credit Union, a federal credi union on behalf of the federal credit union grantor(s). .r red Check here If p= I of the land Is Registered (Torrens) SIGNAT 0 ARY PUBLIC OR OTHER OFFICIAL Tax Statements for the real property described In this instrument should be sent to (Include name and address of Grantee): City of Eaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Date: f O /q /Q LI Site Address: Permit Fee: 2008 MECHANICAL PERMIT APPLICATION 3 i/j iprn0 Permit /4.6 4 Date Received: Staff: v Tenant: Suite RESIDENT OWNER CONTRACTOR TYPE OF WORK PERMIT TYPE Name: N l L 1 rc Phone: f S'a a9a-6G Y Address City Zip: License Name: Address: City: State: Zip: Phone: Contact Person: New Replacement Additional Alteration Demolition Description of work: NOTE: Both roof mounted.and ground mounted mechanical equipment is required to be screened by City Code Please conta the Mechanical Inspector or one the Planners for; information on permitted screening methods RESIDENTIAL Furnace Air Conditioner Air Exchanger T Heat Pump Other COMMERCIAL New Construction Interior Improvement Install Piping Processed Gas Exterior HVAC Unit HVAC units must be screened Under Above ground Tank Install Remove) When installing /removing tank(s), call for inspection by Fire Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation /removal $50.50 Minimum (includes State Surcharge) OR If Permit Fee is less than $1,000, surcharge is $.50. If Permit Fee is $1,000, surcharge increases by $.50 for each $1,000 Permit Fee (Le. a $1,001 $2,000 Permit Fee requires a $1.00 surcharge). Contract Value x 1% Permit Fee State Surcharge TOTAL FEE 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. x t/it� e 0U•r6 Applicants Printed Name x Applicants Signature FOR OFFICE USE Required Inspections. Under.Ground ough In _Air Test RESIDENT OWNER Name: M 1 Y e. 0 Ot i'b Phone: 95'.)- a 1)- 64' i 97 Address City Zip: CONTRACTOR Name: License Address: City: State: Zip: Phone: Person: TYPE OF WORK Contact New Replacement t.— pair Rebuild Modify Space Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures RPZ PVB) Main Lower Level) Septic System Water Turnaround New Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation $50.50 Add Plumbing *Water Turnaround $100.50 Septic System $90.50 Fire Repair (replace (includes $.50 State Surcharge) Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) (add $165.00 if a 5/8" meter is required) New ($10.00 per as built) (includes County fee and $.50 State Surcharge) burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES City ofEaQali 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Date: '7la' Tenant: x a(/z 6- 1 Applicant's Printed Name Site Address: 3 o /4,4,4 Lan) Applicant's Signature Use BLUE or BLACK Ink Permit q/5 Permit Fee: Date Received: Staff: 2009 RESIDENTIAL PLUMBING PERMIT APPLICATION Suite 1 J CALL BEFORE YOU DIG. Call Gopher State One CaII 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 1 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. FOR OFFICE US Required Inspect Reviewed Date: Ground Rough -In:' as Tes, RESIDENT OWNER k kt, U v yt ✓s i Name: N N e' Phone: 1. .r2 2,5 z. 6 6/ I Address City Zip: c Z Z G(..)(-- /Z --l/✓ eC u )LL SYo 1-1— CONTRACTOR Name: J 1 Lc -S Pc u 1-1 h i L C.c., -S License 6 ?-1&/ 1 1- Address: S Z J' CJ l/r 47R; I v`r� City: /3 c. LA.-n, N c.jk. �--t, State: VI r‘ Zip: S.S Phone: 61 --4 t~>7 6/ 1 r Contact Person: /ct ie e w TYPE OF WORK New t Rep i ment Repair Rebuil Modify Space Work in R.O.W. Description of work: t -(.C- t,' ta ',Y,4.(A-`' (A C.0l.(it6: 1'1C e PERMIT TYPE RESIDENTIAL c 9 W 2_ Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures RPZ PVB) Main Lower Level) Septic System Water Turnaround New Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation $50.50 Add Plumbing *Water Turnaround $100.50 Septic System $90.50 Fire Repair (replace (includes $.50 State Surcharge) Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) (add $165.00 if a 5/8" meter is required) New ($10.00 per as built) (includes County fee and $.50 State Surcharge) burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES C!tyofEaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 Date: /0 7 •q Site Address: 3 r 1 6/e-- /emu. x '1 Applicant's Printed Name Applicant's Signature I L.- Use BLUE or BLACK Ink 1 i A /6---04/L. 2009 RESIDENTIAL PLUMBING PERMIT APPLICATION OWL Permit Permit Fee: Date Received: Staff: J Tenant: Suite 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.aoDherstateonecall.orq 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 1 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 pins. Dat e:' FOR OFFICE USE Required Inspections: Under Ground Rough -In Test Gas Te 6 Perfection HEATING E AIR CONDITIONING 1770 GERVAIS AvE LICENSED MAPLEWOOD, MN 55109 INSURED PH: 651-777-7620 BONDED FAX: 651-777-3252 EQUIPMENT I-"-' 1 LI V l' 16i! r- 1 RJ 1 �/ ( g r� � ADDRESS 3 '1// I^/i9 ` 9 nod '11 TYPE /"!d t„� MAKE e et/o. j e;2 P---./.2 CITY 6 vq gin/ ZIP MODEL, l,./ j4p p — V lA/0... .1" HM PH WK PH SERIAL / ' ?5712.2. -7/TECH DATE 3 �; // Y. , INPUT 66 000 ORSAT TEST RECORD CO2 6, 9 % METERED INPUT 67; 0 00 cfh CHIMNEY TYPE /3 -Vey/ 02 d , / % LIMIT SETTING /90 FLUE SIZE 6 in. CO O % PILOT OUTAGE fivci/ sec CONNECTOR SIZE 1/ in. NET STACK TEMP 3 Z 7 TOTAL CHIMNEY INPUT /0d 00O tuh `` L .J� WORK PERFORMED: PRICE RECOMMENDATIONS: TOTAL) I AUTHORIZE AND AGREE TO WARRANTY INSTALL CASH CHECK # PAY FOR THIS WORK CARD # VISA MC _ EXP DATE AUTH # Customer Signature 7a lieu/ START , , - ; WATER SERA Iff PERMIT to " .,.. Knob Road P ERMIT 1_ 0.: 55122 F' I DATE: Owner; No. of Units: r Co 1.4 € d a11 €a t Address: tii; �.ander or L608 Bi. R 5th -411 S e s s 1 Pi 14 .n of./ pd ' Connection Charge: ' Account Deposit: ,� . C1 l' d Size: Permit Fee: Reader No.: -, F to comply with the Village of Eagan Surcharge: C .. p meter 1:ogr misc. Charges Ordinances • Total: /. Date Paid: Date of Insp.: ®�it Insp.: VILLAGES OF EAGAN SEWER SERVICE PERMIT 3795. Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of. Units: • Owner: i.. d r Address: Site Address: 4 + Plumber: a 1 I 1 -r : ) k " : 1 e`: , 350. i agree to comply with the Village of Eagan Connection % Charge: , Ordinances. Account Deposit ,� + r ,_ , _, Permit Fee: Surcharge: B y : Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: