1762 Silver Bell Rd 1
CI .; ` F AGA WATER: SERVICE PERMIT
`37 Q - Xnob Road " PERMIT N O +
gan N 55922 DATE:
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•Size: ” - Account 'Deposit:
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Reader `No.: Pe rmit Fee: : ."° ,.. `i'
` .1 agree to comply with the City of Eagan Surcharge: . ,) r 1,
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Total:
By � Date Paid:`
Date of Insp.: O , " r � /"' ns ,•
CIT Of GA ' SEWER " SERVICE PERMIT
379 ,;' . nob Road ' PERMIT NO.:
E''''''''' ° n iiAN 55722 DATE:
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Sit Address: ",- ''',* ..-.,, : ,- ,--__,, :,----,;.. .; ,. , - , y
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7 agree to comply with the City of E a an Connectio Charge
Ordinances.
Accnt� Deposit
"' .; Permit Fee: i - t• r t t;
" "SSurcjiarge ' '
B y A '"' " Misc. Charges : " -'r ,,
Date of Insp. i , Total
Insp.: ',' , Date' Paid:
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Use BLUE or BLACK Ink
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i ~Uy
I Permit I
City of Wan I D<
I I Permit Fee: ue
3830 Pilot Knob Road I I
Eagan MN 55122 ;.I I Date Received:
Phone: (651) 675-5675 j I
Fax: (651) 675-5694 I I Staff: I
L-------------
2013 RESIDENTIAL BUILDING P MIT APPLICATION
I
Date: 3 I r _ Site Address: 4' 76L SF e t Unit
Name: I' Phone:
Resident/
i Owner Address l City I Zip:
3 Applicant is: Owner Contractor
Type of Work Description of work: IZe. ,r oo ;C L4 { all C
Construction Cost UD j! Multi-Family Building: (Yes / No )
~_~.....s.,...~.-.~.._.,~. C.any. r' C),0'1 cn., ~.tx-cM LL ~ ! Contact: ~ar'a~1.
Address: '7709 (14Ga ~ ~W 11 City: Contractor
$ State: Zip: 3 O Phone:✓ 6 Z
1
License Lead Certifi !dI to
Fif the project is exempt from lead certification, please explain why: (seel age 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRU ING A NEW BUILDING
In the last 12 months has the City of Eagan issued a permit for a similar p1 based on a master plan?
II
_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 cons ered to be public Information. Portions of
the information may be classified as non-public if you provide sp ific reasons that would permit the City to
conclude that they are trade crets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for prote on against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstatem i r
1 hereby acknowledge that this information is complete and accurate; that the work will be I 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 rk 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 approve of plans.
Exterior work authorized by a building permit issued in accordance with the Minneso State Building Code must be completed within 180
days of permit issuance.
tA S x C; LA:n~~
Applicant's Printed Name T Appli n 's Si ature
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I N[ROY C[11Tt/Y TMA TN! AMOV[ 1N A RY[ ANO ODRR[R PLAT Or A BUYVYY OF
Lot l,Black 1,Cedar Grove No. 11,
Dakota Caunty,Minaeaata.
ws auwvcrio er ra rNi s ZOth. owr or ??• ?.o.-
Hevieed Jan. 18th. 1978
-
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA142760
Date Issued:05/17/2017
Permit Category:ePermit
Site Address: 1762 Silver Bell Rd
Lot:011 Block: 1 Addition: Cedar Grove 11th
PID:10-16711-01-011
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Ayi A Amavi - Tchekouvi
1762 Silver Bell Rd
Eagan MN 55122
Angell Aire
12253 Nicollet Ave S
Burnsville MN 55337
(952) 746-5200
Applicant/Permitee: Signature Issued By: Signature
1 ul
)
UANCE
ERF—ORMANCETEsT
Attachtogas line adjacent to regulator
Heating Contractor
Name of Tester
Date
- -
Job Address c.L,
Heating Contractor
Name of Tester
Date
Percent 0
Percent CO2
Percent CO
Stack Temp.
)1, ,
A 1,