3865 Gold Pt BUse BLUE or BLACK Ink
411'
City of Eapil
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
1Vt- 0 31.01'l
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2012 MECHANICAL PERMIT APPLICATION
❑ Please��submit two (2) sets of plans with all commercial applications.
' r0 Date: f /7 Site Address: 33 6S ( /�
Tenant:
'ld a
4,7 ,% Phone:
Suite #: i?
Address / City i Zip: f�%/x��✓h��� (-����1/`- Z
Name: _ i� i� "Sed'l License #:
Address: �l! / &irIi 7 dtis� Q G City: /��
State: �! 5- JZip: � Phone: cc-- -07 V.
Contact: Email:
New eplacement Additional ;/� Alteration
Description of work: rvr0" 6 .r''��
NOTE Rc r>naurtted ns #und t ' irr anica1 epuipkrlt�
Code ; lease con ecfrpectorfor i fcormadpe
RESIDENTIAL
Air Conditioner
Air Exchanger
Heat Pump
Other
Demolition
COMMERCIAL
New Construction Interior Improvement
Install Piping ^ Processed
Gas Exterior HVAC Unit
Under / Above ground Tank ( Install / Remove)
RESIDENTIAL FEES:
$60.00 Minimum Add -on or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) _ $ [p6.3 TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal (includes $5.00 State Surcharge) OR Contract Value $ x 1%
$60.00 Minimum (includes State Surcharge)
- If the Permit Fee is less than $10,010, surcharge is $ 5.00
- If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee
(i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge)
= $ Permit Fee
= $ Surcharge
= $ TOTAL FEE
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.ciogherstateonecall.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.
cc-
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Applicant's tinted Name
p icant's Signature
CITY OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO •
Eac,n, MN 55122 DATE•
Zoning: No. of Units•
Owner•
Address:
Site Address• 3 8(e Si 3 YL 5- 3 8 61T S'h 7 i
Plumber:
Meter No.: Connection Charge•
Size: Account Deposit•
Reader No.: Permit Fee•
1 agree to comply with the City of Eagan Surcharge•
Ordinances.
Byp
Date of Insp.: 7'Zr9'`8 Oi(
Misc. Charges•
Total
Dote Paid•
Insp •
CITY OE EAGAN SEWER SERVICE PERMIT
3795 -Pilot Knob Road PERMIT NO.:
Edgan, MN 55122 DATE:
Zoning:
No. of Units:
Owner:
Address:
Site Address: ----
Plumber:
1 agree to comply with the City of Eagan Connection Charge:
Ordinances.
Account Deposit:
Permit Fee:
8 Surcharge:
Y Misc. Charges:
Date of Insp.:
Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
3115 gel PtI3VIA
2013 RESIDENTIAL BUILDING PERMIT APPLICATION) waspz -3$l;o'3
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Date: 1 Site Address: � - 1 e t . 1R r i , I unit # 38T 3 12'33S (pS fr j
P
Name /� 11
Address / City / Zip: 3$ GO d, yoliN+
Applicant is: Owner 4 Contractor
Description of work: Q e,(0 Q-F
Construction Cost: �� 4K 0 0
City of Eapli
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
vilks
For Office Use
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j%,
Permit Fee: �J 1 �"7
Permit #:
Date Received:
Staff:
�nP � 1�A J� I'it2s. W till'►$ 4 el Phone:1Q51 a T b Be-b r5 1E3,
As ��1
g
1 h, (`�'J Sc I 37b1
CC )
Multi -Family Building: (Yes %Q / No
Company: I lam. `6j1S UCt 6 Contact:
Address: t ' (D Geit
State: ✓ v, N Zip: 5SC71 Phone:
License #: (3 C 03 4-0
Ta_La Err "Si
City: kaSS
Ella 1(JD"i• (ft-ts�
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:
Sewer & Water Contractor:
Phone:
Phone:
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.
x N� l ILA-;- g ol/eCK,
Applicant's Printed Name
x
lic nt's A
pp Signature
)64,
Page 1 of 3
L 15 2020
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 I TDD: (651) 454-8535 I FAX: (651) 675-5694
buildinginspections a(�citvofeagan.com
For Office User 2
Permit #: lid '4 ✓J
Permit Fee: • J t
—T-c
Date Received:
Staff:
2020 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: % " ®2® Site Address: Unit #:
J
Resident!
Owner
Name: Waled tP WoCCIA ►" Phone:
v �� I� �Sf 66id 'r.._ `L B4a.7 1 a
Address / City / Zip: 31 4 513
J
Applicant is: Owner iG Contractor
Type of Work
ta.tet.a.ih. 3 wei,404,.s ► t 0•6r t it 11 MVP, see Me%
Description of work.
Construction Cost: /O/ 700 Multi -Family Building: (Yes (' / No )
Contractor
Company: 1347 etg fe r T o rS Contact: doh.' 274-2.10 F .p
Address: S 184S. rA a m.s4-r7e. le Stru a 4- r+. 1 City: 11 4 p 1 Pica 4.
State: ► t 0 Zip: 55-3 S9 Phone:, to 3 - 7-1 om • Email:] O 1 & Q be t3 a lic ere r~s . coo,
3 72.
License #: 6C-3244 2, rIt Lead Certificate #:
If the project is exempt from lead certification, please explain why:
In the last 12 months,
Yes No
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?
If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. 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.,
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the Clty's
webslte at www.citvofeagan.com/subscribe.
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.
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.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.
x So\A.v. i‘Azio fig
Applicant's Printed Name