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3492 Greenwood Ct SAug. 1. 2012 12:36PM Sela Accounting No.1661 P. 5 Use BLUE or SLACK Ink Date; City of Eaall Per Office Uee 'l :e Permit #: Permit Fee: 4-26/- 3830 3830 Pilot Knob Road Fagan MN 55122 Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 Staff: J 2012 RESIDENTIAL BUILDING PERMIT APPLICATION 11 site Address: 39 S6, 3 / 3'/91) 3y9Gretnwoed C-* S Unit#: RESIDENT/ OWNER Name: tffi tql„} �tS, 5 i✓i1 uwre. a :5;to C. Phone: (I -&3H - 11-3 3 J (� m0 Address / City! Zip; to VI )3? L.�',/ LJc' '+ 1"ir_,- iy r:cl, rn Qi-tAvr\� limn 5 5 '3 LJ V Applicant Is: Owner x , Contractor TYPE OF WORK Description of work: le- �C C)C> C-' p Construction Cost: t D9��S - 00 Multi -Family Building: (Yes / No _) D9 CONTACTOR Company: c"" CAA_ 2L�O -\4 11(1 C.,1N6111 1 t ►I1 Ci Contact: Kar'‘ '^` Address: L{lCO fll,XCe..1 S't 0 Q1 V -, J City: <LUI.” Pa 1"'l_ State: MY\ Zip: 55u) I (v Phone; q 6J -A. -c 1 5 -- -7,1D. License #: CG l2 OW U 5 0 Lead Certificate*: A/A T— a 5 U 3 L/ — If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) in the last 12 rnonths, 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. CALL BEFORE YOU DIG, Call Gopher State One Call at (661) 464-0002 for protection against underground utility damage. Call 48 hours before you intend to dig (o receive locates of underground utilities. yrww.gooh rstateonecall.orq 1 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 wall (he approved plan in (he case of work which requires a review and approval of plans. Exterior work authorized by a building permit Issued in accordance with the IVlinnesota State Building Code must be completed within 180 days of permit issuance. x r r41-Ve. Applicant's Printed Name Applicant's Signature Page 1 of 3 c� May 01 2013 4:O1PM BRUCKMUELLER PLUMBING INC 6516882160 page 1 Use BLUE or BLACK Ink r CityofEaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 For Office Use '�] Permit #: i)Dr! Permit Fee: Loot.' Date Received: 5 -2 ,13 Staff: INFLOW & INFILTRATION PERMIT APPLICATION t/ Plumbing / Sewer & Water Date: 5-1-13 Site Address:.3e4q. So 1#44-11 Greenwao d Court Tenant: Suite #: uFrl r Psil f �l[r `yJ�:Y ,rk�` a° 4�l1i I Name: Lo/fl2,%)L 5i%(i)9,ieaCer .tr- Phone: L.5/-4-15a"/To/ Address / City / Zip: 2 L/1 a2 50 (pill 6feOn wove/ Cour-14, gdyan MA) r'NilRTL iy i .a',14�i5wdrf , of. r� ;Name'eller x � � fur 5>t1, hi 1yi lg�-�. h• +,tl f 0. A m , License #: 0 % 1 $ 5 1- pin Address: !qq / el7/15;ri/1% 21%/ l a" i fi City: �r 9GZ r)r State: MA) Zip: '�7.r� �.',� 3 Phone: 6,51- ($ (it - a a (.1,�r�sr Contactr/ or lit // Email: f, C / _rFm 1 Li: •' 17!� { l' -t. d4 'A PLUMBING (Within the building envelope) ✓Sump Pump Repair SEWER & WATER (Outside the building envelope) Repair Other: Other: ,'vJ I fj giB r �+ ,,V Description of work: / Ltln um - r %t tom ► i. 0C/e. . FEES 860.00 / Each (Includes 85.00 State Surcharge) TOTAL FEE $ t, D • 00 *Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 111 repair costs for reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.citvofeaaan.com/inflow, or City Hall at 3830 Pilot Knob Rd. CALL BEFORE YOU DIG. CaII 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.goDherstateonecall.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. x la I /`� J r Li me r.&der Applicant's Printed Name X ran , Appli ts Signature