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Use or BLACK Ink
_ 1 For Office Use
City of Eap
I Permit Fee
3830 Pilot Knob Road
Eagan MN 55122 fi Date Received: 3
Phone: (651) 675.5675
Fax: (651) 675-5694 t staff. t7 `
L
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: A;Y4-4 s- 14 7' q W i N QC1&&J
y- Unit
Resident! Name: 1 YQ Tc~1J C i ( ~hnne: Saran i -46Z
' 140
Owner Address t City / zip: P- 10 Qn~dlt loos:7 r'1-tv'Alba M J S_~ii' Z
Applicant Is: Ovmer t Contractor
Type of Work Description ofwork:
Construction Cost: Multi-Family Building: (Yes 1 No
Company: i `i'oi? iT+ tvso ~\G U ls~ Contact: #h c ~ R.
Contractor Address: 9 Z-v I- ru 7r i city: 0 G AN.
State: N\L Zip: [ L Phone:,
License a Lead Certificate T ct I
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
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.
CALL BEFORE YOU DIG. Call Gopher State One Galt at (651) 464-0002 for protection against underground 01:4., damage- Cali 48 hours
betwe you mend to dig to receive locates of underg-ound ulihties
I hereby acknowtedge that this infomraton is complete and accurate; that the ;:pork will be in conformance with the ordinances and codes of the City of
t-agan. that I undersland this is not a peimrl, bal only an application for a pemnit4 and work is not, to start wilhrxrl a permit tnat the :work will he in
accordance with the approved plan in the case of stork 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 ~;~f
Applicant's P ted Name Applicant's Ignature
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3830 Pil�t'�n�sb FCc�aad t 1
E�tgan NIN'�5'1� � Date f�eceived;�,Q � �+ 3��J� j
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2�'1� f�E�i[��fil�'I�i. E�I.�il_L)�l�i� PERMtfi AF1'LiCATIt}N
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N, , �_; ;� J� �ons�rucdon Cbst: ' Mulki Famity f3uiiding:(Yes /No'_,_,}
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�'���?���,��f�:�'��,�;� :�., Li�er�se#; . . Lead Certiflcate#=�i��"`,�''����'"`� ~
if the�ro}ec#is ex�rn�#fr�rr�1�ad�e�i�icartican, pl�ase exptain why:(s�e Rage 3 far additit�nal informatron}
e�MRLETE tH�S A��,i4 f?tVL'11'!F CON�Tf��1�T11�Gr�:�1Eil'If St�ll.L�il�t�
In tl�e I�st 13 rnr�ntF�s;has th�City v#�agar�issu���pern�it f�rr�t similar p(an b�setl an a m��ter plan'�
�'Y�s �,�lo tf ye�,date an�i atldress af m�ster plan:
Licens�d F�lumber: Pt�c�ne:
M��h�n�+cal�cs�tr�ctor. `Phone:
��W�r,�Yf�te�r�t�ractta�rr.. Phane=
� r `' �3 , y � �:v �;� ' e� �.�
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CA�L.1.BEFCIRE�FU�##�1�: Cai!Gaph�r Stat�4r�C�II�E(8�59�45#�OQ02 for prntecti�n ag�tinst uctdergrc�uitti utifiity d�ma�e. Gafil 48 fitbur^�
befc�re you intend to dig td re�ive lbcates af ur�dergrountl utilifi�;s: v�nr.gcsnhersiatet�necall.o�g
1 her�t��ackntawtectg�e that tk�is inform�ti4n is com�stete and�c�ura#e,the#the vvc�rk wii!t�a in c�nfc�rmance with#hs�rrdinar�cas ar�c;n�e�c�f tFi�Ctty c�f
Eaga�t; khat i und�:rstand this is n�t a.permlt>but anly ar�apipli�ativn#or a permit, artd vwork is nof tQ stark wit#r�uf a pem�t�t; tC�a#the wc�rk v,ri[t t�ir�:
acc�rdance with�e approvecf plan in the case of�rork which requires a r�view and app�u�f a�pians,
E�cterirsr w�ork aufhari�etl b�a buittling permit issued in�c�ordari�e w3fh fhe Nlinr�ego#a Stata Eiui#di»g Gocl�must bie�csm�fe�it�i��8f1
cfays of permif i�s�anc�.
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APp[i��r�t`s Prirrt��t t��me; Ap�Ali�a�rt` ;�i�}�t�are
i�age i,�f 3
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, ���j l ����[.�/(,� �,-�.DO NOT WRITE BELOW THIS LINE �,?��lp�( D
SUB TYPES
_ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration (Single Family)
_ Single Family Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
_ Multi � Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
_ 01 of_Plex _ Lower Level _ Pool _ Accessory Building
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building*
_ Addition _ Move Building _ Reroof _ Demolish Interior
_ Alteration _ Fire Repair _ Windows _ Demolish Foundation
_ Replace _ Repair _ Egress Window _ Water Damage
_ Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation � Occupancy �� MCES System '—"
Plan Review � Code Edition � SAC Units
(25%_100%_) Zoning � City Water
Census Code hl$!Z Stories --- Booster Pump
#of Units ( Square Feet /7G_ PRV
#of Buildings 1 Length ��! Fire Suppression Required .�
Type of Construction �_ Width �1�
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
� Footings (Deck) Final/C.O. Required
Footings (Addition) � Final/No C.O. Required
Foundation HVAC Gas Service Test Gas Line Air Test
Roof: _Ice &Water _Final Pool: _Footings Air/Gas Tests _Final
Framing Drain Tile
Fireplace: _Rough In _Air Test _Final Siding: _Stucco Lath _Stone Lath _Brick
Insulation Windows
Sheathing Retaining Wall: _Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression: _Rough In_Final
Braced Walls Erosion Control
Other:
Reviewed By: , Building Inspector
RESIDENTIAL FEES � �� � ���h � ��� ,n G�/�r
oL
Base Fee $'8' �
Surcharge �
Plan Review �j?�
MCES SAC
City SAC
Utility Connection Charge
S8�W Permit&Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
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