4633 1_2 Penkwe Way .X.11 WATO ,T ;
- 4144i 1 r it *, o Units: 1 tinit tttbse
: r Orrin Thoi pson` Hone
Wa de 2i
c onnection ° war ' 305.00 pd
Account
F
!fie +tf # S p.m* p.m* ie. • 50
wdherge:
' misc. a cmes: 60 .00,: meter
D ate • Pbid:
9 s" hwp.:
CITY Go. i$Jkfil►Mi .�.�..._ SERVICE PERMIT
•3j9$ P$et Kicb Mind. PE i T NO -
MN `iitix root
Zonh+d• • No: of Units:
Owner: Crr -±r I c,. r Sort I ^le
Adder' t a4.- t� Way L2 C c: e 1.11
Site Arddre e: 4 F _ J . _ en'?: e
Number Y.er1z
C/6/C0 20342 100.00. F,
4 !wa «•Mr do Gtr of l Connection : 425 • °° pc?
Ordlesumess. Afl unt Deposit:
Pintail Fee: 10.00 pd
S urcharge: .50 pc
BY ^ Misc. Charges:
Data. ode s ' ;� Total:
(nsp : - 4-1 y � ) Date Paid:
� •
/3'4 �-
- �_1r
��9 3�, �(a.�� , �,; ���' , ��v� � �a- Use BLUE or BLACK Ink
------:----____�._
� For Offlca t�se �
• j Rermit#: �� �
C��� of�a a� � ; . �� �
� �� Permd Fee: �. �
3830 Pilot Knob Road � � ' �
Eagan MN 55122 C � � Date Received: �
Phone:{651)675-5675 } �
Fax;{651)675-5694 1 Staff: I
f 1
'---- ----------'
� � 2414 RESIDENTIAL� BUIL.C)iN ,t'',� PERMiT APPLIC/�T1t�N
oar�:��-I��-�� s;�Add�s:_��3��' �'l� 3�"�J� /°���'� cv.�f unr�#�
IVame: �c��i�i'�� �'��. /�zx,r/}�7�t...- �p�e;
� �
� R�:S�C��i1fi1 .�
4W11�!' Address f City/Zip: !"i�`}���" �i�-'�
Appiicant is: Owner �Contractor
Description of work: ��'�' ��� �° t ��' "''����
Type�f 1lVork �
Gonstruc#ion Cost: ��<1�� Multi-Family Building: (Yes�/No_�
Company:��7YZs� 7°P �`��
_,��� �' [�sr1%�t�s�9•C��t�`'°'S Contact: _tJ ft� //��`�t�o�
COt1'tr�Ct01' Address:C��(�� ��'��,.,l���- L,',►-�� �°' city:�i ��'�- ����'�.-.
,r J"'�' d
State:�Zip: ���.:�,� �r J Phane:v j2�-��`�j`t'Email:,�►»►�y'1 JY C�,3�5'?�Gc��?�a��v��i r�
License#: l.�C ��`� �f 'T� ��c-_c.�,�-•
Lead Certificate#:!V�- i"°Y 1°>�i'1 t�,3 �°l�
!f the project is exempt from lead certi#ication, please explain why: (see Page 3 for additional information)
COMRLETE THIS AREA ONLY iF CONSTRUC7fNG A NEW BUILDING
�
In the last 12 mon , the City of Eaga�issued a perrnit for a simiiar plan based on a ma�ter plan?/'"^�
_,Yes _No If yes, date and addr s.,r�f master ptan:
�-.
Licensed Piumber: Phane�
Mechanical Cantractor: '
Sewer&Water Con# r: Phone:
N�3TL; ar�r#au�r�i�r�tlacurnen�s flaa#y�u strbmet�r�e ctarr�iafereaE ta�e pubJi����'a�rrr�tt�. �rfions r�f
ert�'�tnr�ta�an may;b+e�lass�d��non-p�b��c if you provieie�p�c'r�'rc r�sons tha�w3i�ld`�err�ari�t��e Ci�y t�-
cancf�de t�a�� are tr�rtl�e sec�e�`
GALL BEFORE YOU DtG. Catl Gophee S#ats One Call at(B51)454-�02 for protection against underground ut�7�y damage. Call 48 haurs
before you infend to dig to receive locates of underground utilities. www ponherstateonecatf orq
I hereby acknowledge that this information is complete and accurate;that the work will be in confoRnance with the ordinance,s and codes of#he Gity of �
Eagan;tMat! understanct#his is reot a permik, but only an appfication for a pe�rnit, and w�rk is not to start withou#a permi#; that the work will be in
accordanc�Hrith fhe approved ptan in the case of�rtc which requires a review and approvat ofpfans.
Exterior work authorized by a building permit iss�.�ed in accordance wFt�t the AAiRnesota State 'Iding�ode m�t be cpmpleted within 180
days uf permit issuance.
�f
X V ' � ,�� . X � ° . ° �
Applicant's P�inted Name ' ant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA168542
Date Issued:04/23/2021
Permit Category:ePermit
Site Address: 4633 Penkwe Way 1/2
Lot:2 Block: 05 Addition: Johnny Cake Ridge 3rd
PID:10-39802-05-020
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 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 -
Pamela Jo Dewolf
4633 1/2 Penkwe Way
Eagan MN 55122--371
Haley Comfort Systems
3708 Broadway Ave N
Rochester MN 55906
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature