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Permit Fee: 10.00 n c':
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3830 Piiot Knob Road ! ►
Eagan MN 55122 � Date Received: �
Phane:{651)675-5675 � }
Fax:{651)675-5694 � Staff: I
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2014 RESIDENTIAL BUILDING PERMiT APPtiGATION
�t�� �..�- '"I,�"�� Site Address� L-1�5d�'-"t�/�g 3 r��5G lil��1���� u„�t:#,
� Name: ����'1✓��-t' t'—�'��. �r::„�hs�r L: .�fi��
Phane: �
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OWCt�c Address/Ci#y/2ip:��r�}'"�' /��,�,� �
APPlicant is: Owmer � Contractor
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Type o�Work Descriptian of work: � G�l� � � ��'�'
, � ;
Construction Cost: ��'c��p Mufti-Famiiy Buiiding: (Yes � !No�
Company:tVf?YZt��°.5� C� c�v7%s�r�C,��17�'S '� C no tact t/r� /�G�7���%
CCirit1'3�f�1' Address:Q�(j�2 Z✓$Y1�✓/ �js� Lr!�}n°Z �d City:j�r'�'�- ��l'ti'"�
� � '�_ G'�`���-��`'�" 1` �
State: Z : �� � PhonB: Email:t �rn�d9 Jd'L�GS`7���d yl�i��u t�v —
Lfcense#:�� I.�� Ll 7� �n v_c:�t--• ,
�eaa Certificate#:M,a-t�,..r>/i 1 r�3 -°1
If the project is exempt from lead certi€ication, please explain why: (see Page 3 for additional information}
COMPLETE THiS AREA t3NLY IF CONSTRUCTING A NEW BUtLDING
!n the fast 12 mant , t1�City of Eagan issusd a permit#or a similar pian based urt a master pla�? '
Yes �No If yes,date and addr f master plan:
Licensed Plurnber: Phone:
Mechan'rcal Contractor: ,
Sewer�Water Cont r: Phone.
1114FE. s=ar�d.�uppartin,g dc�cumertt,s fl�a#you st�btnit are consid'er�d#t�L�e publ`r�in�,r��a�n: Pz�r�ort�of '
��fot�natia+�rnay�e�/ass�ed as nan�pt�blic if yau provide�pec�c n�asotrs#hat wc�crfd�e�mlt#�e C�,y?ta
' " '� � : � ' �� � c�n�Iude#ha#the`� ar�e�eade secref� '� � � � � `
CALL BEFORE YOU DIG. Calt Gopher 3tate One Call at(6S1}q54-0002 for proiection against underground uGlity damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.QOOherstateor�ecail.ora
I hereby acknowiedge that this iMormat�on is complete and accurate;thai the v�rork wili be in c�nfamanc�e writh the ordinar�and codes of the Giry o#
Eagan,fha#1 understand this is not a permit,buf only an application for a peanit,and wr�rk is not to start without a penni#; that the wo�lc will be in
accordance wikh the appmved ptan in the case of v+rork which requires a review and approwat of plans.
E�cter�or v�ork autharized by a buildl�permit iss�d in accordance with the Minn�ota State ilding Gafe mt�!1�complet,ed within 180
daya af parmit issuance.
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ApplicanYs Rrinted Name a+tt's Signatare
Page 1 of 3
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� For Qf#tce U�se-------- i
� � i Permif#: �,J� �
C�t� af���a� �o ; u� � �
� Permik Fee. �
3830 Ritot Knob Road ';
Eagan MN 55122 � Date Rec:eiv$d: �
Phone:(651)675-56Z5 i i
Fax:{651)675-5694 I Staff: I
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� � � � . . . � . . � . . � : .. � .t���..��� .�� �.�.��1
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: �°'��`!� L-��� �'�f---���� r r��.rG ���j��/'•\
�
Site Addn�s• tlnit#•
� p {
� tVame: tJC?fT-1�i�Lf' ��� tr�t�.�ll�it..:.. � Ptrona �
ResrdenU ;
�'?Wil�t' Address l Ci#y 1 Zip:�7�✓�°' ��
APPficant is: Owner �l�, Gontractor
��
Type vf Wc�rk
Description af work: ��'� ,�?�� � �� -'R'��
Construction Cost: ��'f l�P � Mufti-�amity 8uiiding:(Yes�/No�
Company:LVCJYZtJ�5� C�c'�v'1�y'v9��?�t�/'S '� Contact� r r-vt /�G�t1a�'
Address:�t'��� Z'�'�c��'��� L.�j��t /�d City:���'�2- ��I�I.A'�.
C�ntra�tc�r �
" , �J2--��_fj�
State:�Zip; ��,, Phone: ' Emai1:t�►rn��9t3Yt,�5'T��c�Yl`l'�i/���r�v —
�YJ v_C:t7 r�a
I.icenss#:13� I.�`� � 73 I.�d Cgrt+�cate#:1V�.t-',...�=»Jla 3 �-1
!f the pro}ect is exempt from lead certifcafion, please expfain why: (see Page 3 for additionat information)
CflMPLETE THlS AREA ONtY tF CONSTRUCTING A NEW BUILDING
!n the last 12 mon# , t#�Glty of Eagan issued a pertnit for a simifar plan based cn a mas#er ptan7 '
_Yes _No 7f yes, date and addr f master ptan:
Ucensed Plumber: Phone:
AAecl�anical Contractor:
Sewer�Water Gont r: Phone:
1�ft7T�'. s'a�al!sr�p�orting documents tltat,�au submit are consFdered tt��e pubtic in�'�rm�ti�rn. Por#iarrs bf
rnfor�atioR�rta�r�e�la�s�if"�ed as non=pt�bli�;jf yo�provide�p�i�"fc reast�ns#h��rt�rld�ermit##�te C�y tc�
c��clude#lrat�re ar�e d�rde�rets
CALL BEFORE Y�U DiG. Cail t;opher Sfate One Call at(6,51)454-0002 forpratection agair�st underground uUlit�r damage. Cait 48 hours
befiofe you intend to dig to receive toqte.s of underground utitities. v�u;r.aanherstateonecaiLorg
1 hereby acknowledge thet this iMo►mation is c�mpfete and accurate;that the Hrork wiit be im m�famance wiih U�e ordinances arid codes of the Gity of
Eagan;fhat i understar�d this is nof a permi#,buf only an application for a permit,and vvark is not to start without a pertn►t;'that ihe uvork wiil be in -
acxordance wath�e aPproved ptan in the case oi vwrtc which requfres a feview and aPRravat ofplans.
Exteriw wark autharized by a buiiding permit issued in accordance with the Minnesota Sta#e iiding Code must be ccmpieted within 180
days of p�rmit issuance.
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APplicanYs Printed Name arlt's Sigrtature ;
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA152505
Date Issued:10/18/2018
Permit Category:ePermit
Site Address: 4661 Ridge Cliffe Dr
Lot:4 Block: 06 Addition: Johnny Cake Ridge 2nd
PID:10-39801-06-040
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Lu Ann Aasen
4661 Ridge Cliffe Dr
Eagan MN 55122
Fireside Hearth & Home
2700 Fairview Ave N
Roseville MN 55113
(651) 633-2561
Applicant/Permitee: Signature Issued By: Signature