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�Sep 03 13 01:03p Westonka Mechanical 952-472-4961 p�2 y_ __ <br /> 09/03/2013 La:18 `J5'L'14yQblb ���'�-� <br /> '�� xoia cnv t�oxL� <br /> /��� O�Bax OroQo D�t�&caivcd: Permit N <br /> f '� <br /> +,Y�� 2750 Ke�ky Parkway ❑in-Hauac SAC Determinatlon Form Complc�d <br /> �-,\! � , �j Cry�eaf pay,M1v Si32� <br /> .'•ti,�,4•i�Hn��'�� (9i2)Z44-4600/Fex(952)249-4fi I6 Apytored Hy(ilRequirodJ: <br /> CTTY OF OR4N0—SEWER &WATER/GENERAL PER�NiT <br /> (*Note:Some pem��b mar roquiTc approval by�he Bnilding 09ieixi aadlor public Warka Departmcnt•} <br /> (�l[.L PEHA�1'�S- IYfar he anhiett Io tae�r aeview end mey�ot be i�ned w�en the inoliention(t rettivecr <br /> CrENERAL 1NFORMA�ON <br /> 1. Yau may appty£ar utiliry permits by mail or in person ac che Ciry of�ic.es, <br /> 2. Mailed in applieations are subject tp the postage and banQling fee shown below. Pezmi:cards w917 <br /> be sent by�etnrn mai[within 2 business days. <br /> 3. Pecmit,�arc aot vaNd antil you e-eceivc a permit asrd. <br /> 4. Work zriust not begin unless the permii card is avai�abEe on zhe job site. � <br /> 5, Utility eonre�tion pern►its rnay be issued to licensed contractors vnly. <br /> 6, Contact the Public Works i7epa�tment(953-Z49-46Q0)far ntiiiry siub a5-built locatians. <br /> DO NOT EXCAVAT�IIY ANY S7'REET AND DO NOT tAP A�IIf MAIN without`e:press <br /> approv�l�f the PnbFic Works Department. Issuance ofa pamit does no:�raQtthis approva3. <br /> 7. Alt work m�t be de�e�n aceordance wi[h Staee Code rzq�irements. <br /> 8. AI!wor�must be inspecced before i:is cov�red. Cail{952)2a9-4600,24+hour aotice reqsired. <br /> TYPB OF PERNifI <br /> Check AlI 7hat A t <br /> �Rasidential(May Requir�c Approval) ❑Commerclal{Approval Requir�� <br /> �New Gonnection ❑Additionai Coaneeeion ❑R�Connecdoa ❑Repnirs ❑ D�sconnxt <br /> ❑ Wetcr Availabi:ity Con.cuction For Futur�Hook-Up to Water <br /> Job Site/Ow�ner�nfomiation: <br /> + . <br /> Site Address: � ��t� �lae• G1 nN !�/`. " <br /> � <br /> Owner: Mailing Addsess: <br /> c��: z�p: <br /> Hexz�.c Phone: Alternate Phone: <br /> Contractor Information�: • <br /> Contraceor, ��5��''k� .S c..� Contact Person: P�� � , �`' � <br /> Address: �75�� Cr�_ ,�� � � State License�!: <br /> City: �'�'�.o��.�z� Zip:S��'rlExpiratinn Date: <br /> Pl�one: ��v�-t{7,1� �cl�j Aiiernate Prane: �j 1� - 7`7 f" �l � 7 � <br />