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CIT : 4 EA�G_A WATER SERVICE . PERMIT
l n-.21199 PERMIT NO.:
x ' 55121 DATE: _ 10 -11-83
R N o. of Un 1 Of 4
Owner TO]. lefsafl Bides
Mdress:
Site Address:
W31 OW Way L69 X31 Hill 4th
Plumber: Ganz Ryan
Meter No.:
Connection Charge: 4 a . t !f } kiu
Size: Account Deposit:
Permit Fee: 10.00 pd
Reader No.: i 50 pd .
1 6gros to comply with the City of Eagan Surcharge:
Ordiaoacot.
Misc. Charges: 60.00 Pd met
Total:..
Dote Paid:
Date o Insp.: ; � ink
Use BWB or BLACK Ink
-T-_
For Office Use
• i Permit o ~ ~ ~ 1 I
MY of EalanI ~ ~ as
I Per+nit Foe: l
1
3830 Pitt Knob Road I late ftoowd: 10 I
n MN 56122 I
Phone: (651) 67541675 I s I
For. (661) 67541684 W
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Emb. / Site Addrew.3?CV, 3 BP.E, 3 7'o N, 3Wo6 l~ 1 L..C-a W Wp Y _Unim
xv a G 1 "
7 • 3 -
3
Name: 61o A C T 14 r4 .,J 4 6 ~ At Z. y T Phone:
'a` p ~o E~ f`itK
er Addrm / City I Zip: V S0 Q All A3
• Applicant is:. Owner 2, Contractor /o'`j '~7
i :0tt Deacription of worts: `TE/1-2 O a Q E F
Construction Corn Multi-Famliy Building: (Yes /No
Company: 1I E J 41- rt.2~oR tae P. CoMat aravia Va" t2-R S
Addrm: ~o s 60~ ST . City:
Stabs: Afkj zip: SS'yi 9 Phone: 10-'A - ~6/- 4,;z y3
License C A 9";., 3 / Lead Certificate W.
If the pmled is eMmpt from lead certification, please egplain why: (see Page 3 for additional information)
~ QLD(o3 t r ar-' a-iiLr Pos; l F'7 ?T
COMPLETE THIS AREA ONLY IF CONSTRUCTING A ~N , IIMILPJNG
In the last 12 momtire, has the City of Eagan issued a permit for a almilar pain based on a master plan? '
Yes Wo If yes, data and address of master plan:
Licensed Plumber, Phone:
Mechanical Contractor. Phone:
war & Water Contracl or: Phone:
CALLLRLY 0119. ftmn one call at (w) e34, m for pnotecoion a9wrrd underground udwy damage. Call 48 horns
Underground udlftbs, wNnN.A4nleoner~all-arg
I hereby acknowWp that this inbmadop Is ooWIW and acarrate; llwt the work wlil be in conbmarice with the ordinanom and codes oftine Qty of
flan; that I undo 8WW this Is not a permit, but only an appGcom for a permit. and work is not to shut whhout a permlt: that the work wN be In
9ooorder~oe wqh tns epo+ovw Wan nn ti+o rvw erwon~ wHlah rogWroe a rbvlevr,end aDDrovar or Plana.
ExWd0r *v* authorised by a building ponltit Issued In accordpnco wkh the Mlnmesom Sods Builds Code must be oomplebd wilhlm 180
days of permit issumme,
x f~uR2rS
Appiioant's P1 1 i;ad Name x
AppllranCs Slgnnature
Page 1 of S
Z0/Z0 39Vd 1NICW 1X3 139 L9Z9T98ZT9 66:ZT 6T0Z/9T/0T