3429 Highlander DrRESIDENT 1
OWNER
Name: . 11 ,/ irr'1,, „i, ' L . 14 .0 . i..f.a: h one; 9a CTG1 4
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Address / City / Zip: Cd l �,[ r icy ! Y(.+
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Applicant is: Owner Contractor
TYPE OF WORK
Description of work: / / . It` , A. A t r 'i.r /rl _ L A._ !..
Construction Cost: 11 / W O a I. . Multi- Family Building: (Yes / No
CONTRACTOR
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Company: T D if A C Contact t:L ' V
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Address: ( , City: T: /Au/3 t tt
State: 11 Zip: 5.54/ 6) Phone: l eic9— 62 f II
License 5: (FM I C� l5 [) Lead Certificate #: A-/A
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
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
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:
Phone:
Phone:
Phone:
NOTE: Plans and supporting:document§ that you submit are, consideredto b.e public information; Portions of
the information may be classified as nonpublic ~if'you provide specific reasons thef,would permit.the City to
conclude that they are trade secrets.
Jun. 8 2011 2:44PM SELA ROOFING
Date:
City of Eaali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675 -5694
Applicant's Printed Name
(r . 4 1?-93(0
Date Received:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
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Site Addres i4 /4 . . ( `a A�, 1 `t 21 f ni
No. 6530 P. 11
Use BLUE or BLACK Ink
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Permit #:
Permit Fee: /33
Staff;
CALL BEFORE YOU DIG. Call Gopher State One Gall at (651) 454-0002 for protection against underground utility damage.
Call 4$ hours before you intend to dig to receive locates of underground utilities. www.aopherstateonecalJ 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 plans.
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Applicant's Signature
Page 1 of 3
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA139519
Date Issued:10/26/2016
Permit Category:ePermit
Site Address: 3429 Highlander Dr
Lot:1 Block: 07 Addition: Surrey Heights 4th
PID:10-73003-07-010
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Terrance J Kambeitz
3429 Highlander Dr
Eagan MN 55122
Applicant/Permitee: Signature Issued By: Signature