3476 Greenwood Ct SRESIDENT /
OWNER
Name: ir- t ■ 'tc , s - 1 - 1,:ir\ t,l ( 66C) C. Phone: C)5
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Address / City /Zfp: � t.. ? ' (..d (,JeS+ 7 r Kt. ' . V �� �" 1� r. w
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Applicant is: Owner X( Contractor
TYPE OF WORK
Description dwelt Ce..'C () C""
p
Construction Cost v' Oct s Up Multi- Family Building: (Yes X_/ No )
•
CONTRACTOR
Company: 6 (4a_ t -'b - 1 o �i'll t. c-11 N Contact: <c;,r t i~
Address: t_1 [CO tE XC'r-A St Or g \ V d City: 51; . LCA 1 S Pa r - k_
State: VYlY\ Zip: 5 5LI 1 Lo Phone: Cl 6 1 5 -- dd L
License #: C tit OD \ 0 50 Lead Certificate #: AM T- 5 03 -/ - 1
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
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:
Licensed Plumber: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
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,
Aug. 1. 2012 12:35PM Sela Accounting
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 676 -5694
Applicant's Printed Name
City of Eaau
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
No 1661 P. 3
Use BLUE or BLACK Ink
For Office Use
I /
Permit #: / (J -66 5e)
Permit Fee: 6- /,) • J�J
Date Received:
Staff:
J
Date: / I /I Z Site Address: 3470, 34 - 7Z, 3t17t/ Greenwood C-k S Unit #:
CALL BEFORE YOU DIG. CaII Gopher State One Call at (661) 454 -0002 for protection against underground utility damage. Cell 48 hours
before you Intend to dig to receive locates of underground utilities. ywv.gopherstateonecall-orq
I hereby acknowledge That thls Information is complete and accurate; that the work will be in conformance with the ordinances and codes of the Cl[y of
Eagan; that 1 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 will) the approved plan In the case of workwhich requires a review and approval of plans.
e xterior 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 a r \Y1
(1_9-JAT-SL._
Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA117763
Date Issued:10/23/2013
Permit Category:ePermit
Site Address: 3476 Greenwood Ct S
Lot:4 Block: 07 Addition: Surrey Heights 1st
PID:10-73000-07-040
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Tony Boerner
2090 County Road 42 W
Burnsville, MN 55337
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 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 -
Lisa M Anderson-goven
3476 Greenwood Ct S
Eagan MN 55122
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature