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4688 Lista Pt ñ ÿþ ÿþþýüüûüúûúü ùýýþþðññøþ ïîÿääì ìïï ÿþ ýüûúù ß ã ø üûú÷ö úù ß ã õ ÿ ÿ ú ô óý ò þ ú þéñè þ ððñïð ò ùéîúèçñêïêðïï ÷ù ó ÿùæçñêêñ öõõô óò úú äÿ íÿß ý ÿ ñïúú ðóøðïï ÿò÷ññ úúëûò÷ññð éñèðìñï ó ýûöÿó óå óúúóóä ÿ úûöóúúý äòãûä ÿâ ê úúÞ ÿ ûÿ WATER SERVICE PERMIT CITY OF tAGAN PERMIT NO.: 3795 Pilot Knob Road DATE: Eagan, MN 55122 No. of Units: Zoning: --- - - - -�— Owner: Address: Site Address: Plumber: Connection Charge: Meter No.: — Account Deposit: Sae: Permit Fee : ------ ______ Reader No.: of Eagan Surcharge: agree to comply with the City Misc. Charges: Ordinan es Total: Date Paid: D Insp.: nsp.: Date of Insp.: • CITY OF EAGAN SEWER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: -- — Address: Site Address: — Plumber: 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: Use BLUE or BLACK Ink r I For Office Use I _ v I City of EaEdn , Permit#: J l~ a I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 I Staff: I .T I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: D l Site Address: glAY141 &M Pt- y40j y` C 11 Pt Unit Name: I \ 1,PGL°C_L I s7 Phone: Resident/ Owner Address / City / Zip: Applicant is: Owner contractor Type of Work Description of work:.-,/~ /+e /-G y r Construction Cost: Z 7~y~ Multi-Family Building: (Yes No Company: D ~h •l Vole 1 "l Contact: L A5 e Contractor Address: 1ey ev` City: r State: Zip: S~f ~3 3-7 Phone: LJI~ - License 01-V ? ~FG 6 4(_'7 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 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: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of I the information may be classified as non-public if you provide specific reasons that would permit the City to ( conclude that the 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.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 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. l x 04-11 L! 7 jL° x Applica 's Printed Name Applicant's Sig ature Page 1 of 3 Use BLUE or BLACK Ink r----------------� I For Office Use � � � Permit#: t �� City of �a�� ; . ; Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 � Date Received: � Phone: (651)675-5675 � I Fax: (651)675-5694 I Staff: I 1 I 2015 RESIDENTIAL BUILDING PERMIT APPLICATION �',�q� Yr gZ �rsf� r� Date: l Site Address: � Unit#: � � � �` ��.� � � �� ,, Name: ��It��--� �� Phone: �`�Resident/ � � �Ow�er � _' Address/City/Zip: �� ,�.� �` � �`��' A licant is: Owner �Contractor �.. .: ��. ,��. . .�,.:� Pp � � � � � � �� ' n �� Description of work: �� " �t�/�. �,�TYp� of Work ,� ��..,�� g�:�„�� ,�� Construction Cost: Z'�d�p Multi-Family Building:(Yes � /No ) �� ; � ..-„ � � ��-� , ' P Y'�71T�/-�IZI��—�G�.-- , � � Com an � OL � Contact: �� ,�� , ��Sr �i�t�tu�Y> C�' _c�ty: ��/�«t'�'�. �� 3� xt.� � ��: Address: Contractor - �- , � ., �� . State:��Zip:�� Phone: -�`G� ��maiL �� ; � �� ;��. t License#:�3�� Lead Certificate#: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTIING 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? �I _Yes _No If yes,date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer&Water Contractor: Phone: � NOTE Plans antl supporf�ng doc�uments that you submit are*co�ns�%red to��e pub/ic�nform�:t�on� ortrons of� ��the rnformat or��raay�be�c/ass�fieal as n�o�i publ�G rf�you��ro�fde�sp�eci��ic reasort��fh�f wou� Fe r�# ��fo��; �� ;_ ; ��.�.�` ��:� �.�� x . � �conclude�tha#=the ,TMare,�trade.seci ets.��...��a >��4� �;� ,�,.., ,�; -�'� 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.popherstateonecall.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 S�tate Building C e ust be completed within 180 days of ermit issuance. � ��s x �. x ApplicanYs Printed me App icanYs S ature Page 1 of 3