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1924 Southpointe TerPERMIT City of Eagan Permit Type:Mechanical Permit Number:EA124424 Date Issued:07/01/2014 Permit Category:ePermit Site Address: 1924 Southpointe Ter Lot:041 Block: 03 Addition: Sun Cliff 3rd PID:10-72977-03-041 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. Kathy Will 2609 Hwy 13 W Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 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 - Federal National Mortgage Association 14221 Dallas Parkway Suite 1000 Dallas TX 75254 (616) 325-1255 Airic's Heating Llc 2609 Highway 13 W Burnsville MN 55337 (952) 345-0032 Applicant/Permitee: Signature Issued By: Signature - Use BLUE or BLACK Ink � ForOHlastJs�'---------� I Cit of a �Il � p���� � �`��� ; � � � , ���. � � ���: � 8830 Pllot Knob Road � � Ea{�an MAN 55122 j Dsle Receiv�d: � I l / j Phone:(851)679�8675 I � Fax:(651)6755684 I � � I I ♦....�������������r�...J 2o�a RESIDENTIA� BUILDING P�RnniT AP���caTroN �-l�—ly r4oz,o1�,o�,ott;�o, /� Oate: Sf�eAddrees:14i�,_�wi��?, zo,x�,xY Sau;,�/Po�.JT'E 7�2 Unit�: I �' Name:��o A C 7' /�1�4 n.l�1��1'N E�U T .7"�3 C Phone:7G3 -s'43 �7�� � , Address/City/Zip: �5 d � �e.i4 �-^�2 /�t/ � � �oi.�E.� +ViK�� . . � . /�'�.► .S�y,�h . Applicant Is: Owner �Contractor T �,;� .:..";�' Desarip�ion of wor�t� /�L'�.o✓z, e� Q ���f c E �i d�kJ co YP ���k� ' � � � Cohsbuction Cast��9 �� �" Multi-Family Bullding:(Yes x' I No� , . .., • Company: ��/ ���clt�oR /Y/�i,��. �� Contact �wv�9 1��2R�S ��a�7°� �aaress: �/os C�1 6v� S�. ��y; lhP�.S �`'_. � Sqte: /�� Zip: .S�S`�� 9 Phone: �O�� �6�~ �o z�l3 ' � : �icense#; �e �y/�s I l.�aa certificabe#_ If the project is exempt from lead certiflcatio�, please euplain whj/: (see Page 3 for additional information) �[-�la5 �1..)�¢� �a/Lr PoS, / }y � COMPL�TE THIS AREA ONLY IF CONSYRUCTING A NEW BUILDING In tAe laat�2 months,has the city of�agA�Issued a pennk for a��mflar plan based on a maater p1An? �Yes �No If yes,date and address of masbar plan� I.icensed Plumber. Phone: Mechanical Contrs�ctor: Phone: Sawa��VY�ber Contractor: Phono• NO�':��. �..,. ,... . . �-�. � �.<.. ' ,� � �f. '.1��!�',. �- � . ,. _ ..,�!�4�. ,j�,fa�'. . �� Y�% '�„'4y",- .:?' ;,i;" �i• �'W,il �a•� ,�?�.,A t� �:''.:����1�• "t °S.. CA�,L F.f�FOR�YOU bIG. Call Gophq Sbete pns Call at(661)45�.00pZ for proteclion egalnst underground utlliry demsge_ CeM 48 twurs befare you Intend to dig ta recelv�e lacatee of undetground utililies. �vw. op oherst�teon�q.c,� I hergby acknowledge that Ihis in(pmtation is complate ana sopuratg;Met�he woAc will be in Contomtance with the adinanoes and codes of the Gty ol F�gen; that 1 underbyqnd thig is nol a perntk, bu!oNy an appACBtion for a nermR,and wqrk ie not to stsrt wiThout a pertniN, Ihat thc worfc wiU be In� soeo�dana.w�tn tho approv�d plan In rfte Caso oi work whIG1 nBqU1nES a�evi81N 811d epprpv9l C1 plans. Exbedorworic aulhorf�sd by a building permit iSSUad In a�qrytance wfdl tNe Minnoso0s SEate BUlldl Code must bo oompl6ted witi�in 1$0 deys of pertnK Fssuanr,e, z ��Av�� 'g�R2�s X Applican�'s priM�ad Name Appllaant's SIQna� P�e 1 of 3 TB/Z0 3Jvd 1NI�W 1X� I3g L9Z9�98ZZ9 ZS�ZZ btOZ/ZZ/L0 Use BLUE or BLACK Ink � .-------------- , � Fa or�ce use � � i �r,• f ; Pem,it#: (� � � t,l� �! �� � � � �„�F�: 5 I S� ; � � � � 3830 Pilot Knob Road �''�h� F/� �!"!'�°'� I � � „ � Eagan MN 55122 -�;.� � Date Reoei�red: I Phone:(651)675�',675 � Fax:(651 j 675�5694 � �' I � �.����.����w������.��J 2013 RESIDENTIAL BUILDING PERMIT APPLICATION �.�. /� 9n oy o�,og rc� /� Date: �� Si�Address:iSiy,��;�g, xu,xx,x 5�' Sov7-�Pe�.��~�' .7."�2� Unit#: �. Name:��o f1 C T /y1,q n3�4��rit E v T .�"�C Phone:7�3 -s'9 3 - ��7 0 R:� I G � ` t/�� bv�mer . ' aderess�c�y�z�p: 8 so a ��,a �--�,e Av ,� .� � p o E,..� �rr•�.► .SS"�',�,7 �. APpiicant is: - Ov�mer �Contractor T , �'IdV41�c. Description of work: T£� �F-�= � (Z E- �F — YP�:.. � Construction Cost��� 7��.� Multi-Family Building:(Yes � /No� . .. Company: �E 1 £,��rE.2•��e /�'17i,.s�. �� Corrtact ��av�� �`'��5 Cc�ai�r�::;" add�ss: �os t� 6�� S�. c;ty. �PL S. . s��: �� zp: ssy�9 Phone: (a�z - �b�- �x v3 : � ,. ucer�ss#: �� .�YI�3/ Lead cerdficate#: If the project is exempt from lead certification, please explain why: (see Page 3 for additionai i�ormation) ����s �J�Q� l��,�r Pos. i 5+7 � COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 morrths,has the City of Eagan�susd a pertnit for a similar pi3n based on a master plan? _Yes _No If yes,date and address of master plan: Liceosed Plumber. Phone: Mechanical Contractcr. Phone• Sewer�Water Contractor. Pho�: WO�.��af' " : .. „ . . r t/�e.��%rr�i'oi�:'�.�!��' ' :'+` '. ' .• �'�� �� •,,��. .'�" ,,, •,,.'�.Yrr•� ,���'• ..• .y _• '�',�a`f :a;. ,�,`'� '< a So' �`^' S.i X�SaG �:� �'s..� - t �.�'��j.�r�;.• �ALL BEFOR�YOiI DIG. Ca��Copher state o�Ca�i at(651)dsa�o002 for protedion against underground uduty damage. Cau 48 hours b�Y��d to d'ig co r+eCeive bCates of undencjround uGT�tes. www.002h_erstateonequ.orv I herebY�thet tlus infortnation is oanplete arld a�rate;that the work will be in confomianoe wifh the adinances and codes of ihe Cily of Eagan; that I un�and this is not a Cerrnit.but only an appGc�tion for a pein►it.and work is not to start�a aertnir.that the wcric wiu be in aoee�danc:•w:�►a tM aPP`ovod Wan Ut the cese af woMC whNY7 I��WfCS 8(@ViBVH 8fW 8�(NOV81 OT p18�i5. Exterior work aulhorized by a buildln9 Pennit issued in accordance with tha Minn�Stabe Butic6 Code must be rompieted wid�in 180 days of Permit�u8�. X ��Avi� �J�ILJs X Applicant"s Printed Name APPlicanCa Signaturo Page 1 of S rF .5. • - a S - "tip" .0.-t �-. 12 rte' I� ! S ra , i 4 ' - •a.. r• • a - • spa °,,,.. —.- ., . .as .' SITE ADDRESS 1924 SOUTHPOINTE TERJnit # Permit # 12413 TYPE PERMIT # PERMIT CONTRACTOR DATE TELEPHONE # PLUMBING H.V.A.C. ELECTRIC ? b; L'' S/ 5 :f !171S-7 4V17 G' C.i INSPECTION DATE INSPECTOR OTHER FRAMING ROUGH PLBG. all ROUGH HTG. - AG U G INSUL FIREPLACE FINAL HTG 7 - 3 r? FINAL PLBG - 7 - G?7 = u' %' -? .mar/ 2 UNIT FINAL CERVOCC CITY OF EAGAN WATER SERVICE PERMff 3830 Pilot Xnob R»ed PERMIT NO., P. O. Box 21199 DATE: Eagan, MN 55121 i + No. of Units: Zoning: Owner: Address r 't - 11 t?1.nIIItE' rr I ?2 Vl ?r i?l.... r Site Address: . _i enze Plumber: 3 0 ion Charge: Meter No.: Size: I Z ?? • c ? f y I?M?sit. ' Reader No.: ? 'll'????''i°' " . ?ecp 0,? tai 5lta 1 ,l r .P' 1 ^r 1 some to eanphr reillr tl?w oerJinena.. OTotal: r k k,Q ?Q Dote Paid: -? e of Insp.: Insp.: p,.- k c-v s- v a m b c F S FYI / CITY OF EAGAN 3830 Pilot Knob Road SEWER NICE PERMIT P. O. Box 21199 PERMIT NO.: Eagan, MN 55121 DATE: Zoning: No. of Units: Owner: Address: Site Address: Tort'..- ; Plumber: E - 34 1 Nees to e. *h wkh as city of Began Connection Charge: Ordineneu, Account Deposit: r Permit Fee: : n Surcharge: By Mist. Charges: Dote of Insp.: Total: Insp.. Data Poll: CITY OF EAGAN 3830 Pilot Knob Road WATER SERVICE PERMR P. O. Box 21199 PERMIT NO.: Eagan, MN 55121 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber. Meter No.: Connection Charge: 3i?` ?u? Size: Account Deposit: Reader No.: Permit Fee: 1 epees to GM* wuh the City of Began Surcharge: Orrirwwas. Misc. Charges: Total: By Dote Paid: Dote of Insp.: BUILDING PERMIT Receipt # N? . 1?413 To be used for Est Value $616,000 Date 19 . Site Address 1 OtJTHPOINTE I'ERRAC_ r- Erect ? l Occupancy Lot Block Sec/Sub. SU,4 CLIFF 3RO Remodel O Zoning R3 Parcel No Repair ? Type of Const V . Addition ? No. Stories Name -).-,Vt:L0?ERE INC Move 13 Length 1 z 7 6 `Cf S'1 . 2 0 $ Demolish ? Depth 3:0 Address ,'; 35 - 5405 Int. Impr. 11 Sq. Ft City Phone e Install ? 0 Name E'41' CORP Approvals as Address Cl//?- Assessment '' City Phone Water & Sew. Police I W NameFire Address '" Eng. i W City ; .? JP4idne 4 i 1- '-7 4 6 9 Planner Council I hereby acknowledge that I have read this application and state that the Bldg. Off. b/7/86 information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. APC Var. Date Signature of Permittee A Building Permit is issued to: o all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagai Building Official CITY OF EAGAN 3830 PNot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 Permit i ; i Surcharge Plan Review SAC Water Conn. ' Water Mete r Road Unit ` ' `' • t Tr. PI. 172.0( Parks A Copies i Total i the express condition that Ordinances. Permit No. Permit Holder Date Telephone M Plumbing 7) s H.V.A.C. 7S73 L(? ?6 Electric , I Softener Inspection Date Insp. Comments Footings I Footings II 6 Foundation Framing Roofing $C 440- Rough Plbg. ll-lq-7 "1511 Rough Htg. Insul. Fireplace Final Htg. Final Plbg. Bldg. Final 3 pp r? Cert. Dec. Deck Ftg. Deck Frmg. Wen Pr. DKP. A-Zft 014,14* ?.6r? ? .cs?s It PERMIT # / MECHANICAL PERMIT RECEIPT # s e p Qj CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE 7zo CONTRACT PRICE. PHONE: 454-8100 Site Addr M BLDG TYPE WORK DESCRIPTION Lot floc k /Subs . 4.r R N es. ew m Name 91 4 N < lei 1 l M Add u t -on 9 Addr L- l1 : r ,, u v? Comm air Re CA City P hone ?e' . Oth p er Name TYPE OF WORK Forced Air Boiler Unit Heater Air Cond. Vent Gas Piping Outlets # Other S -a 914Ig,?. k-L M BTU M BTU M BTU M BTU CFM 14. FEE S/C: FEES RES. HVAC 0-100 M BTU -$24.00 ADDITIONAL 50 M BTU - 6.00 ADD-ON AIR COND. 0-24 BTU - 12.00 ADDITIONAL 6 M BTU - 6.00 GAS OUTLETS - 1.50 EA COMM/IND FEE - 1% OF CONTRACT FEE MINIMUM - RESIDENTIAL FEE - 10.00 MINIMUM - COMM/IND FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) SIGNATURE OF PERMITTEE FOR: CITY OF EAGAN PLUMBING PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 CT PRICE PHONE: 454-8100 Site Address 1 7 c Lot I f? Block S? Name _ Address c city Name I '"? • ` c Address p City PERMIT # 7 RECEIPT # 4 d~ DATE: 1- a , BLDG. TYPE WORK DESCRIPTION 3 Res. New Mutt Add-on - Comm. Repair Other FEES COMM/IND FEE - 1% OF CONTRACT FEE MINIMUM - RESIDENTIAL FEE -$10.00 MINIMUM - COMM/IND FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $30 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) FOR: CITY OF EAGAN N FIXTURES TOT4 Water Closet - $3.00 Bath Tubs - $3.00 Lavatory - $3.00 Shower - $3.00 TEKitchen Sink - $3.00 Urinal/Bidet - $3.00 -TLaundry Tray - $3.00 Floor Drains - $1.50 7°Water Heater - $1.50 Whirlpool - $3.00 =Gas Piping Outlets - $1.50 Softener - $5.00 Well - $10.00 Private Disp. - $10.00 Rough Openings - $1.50 v S FEE STATE S/C: - GRAND TOTAL INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: Illf it 10 fkc4 1 .0111 ItPOI N7 f TER ` UH C:(I F f 3k11 PERMIT SUBTYPE: I 1ti 0111` I"(, 61) 11 It INO 0.18444 0 / %'1 1 14)(i APPLICANT: rt 11 h I .' ) b 4 t, TYPE OF WORK: ill .1 1. 1 , 1 41 1 IHAI c•1 41 R1'PA1R d ROt11- I Hia/`+I O'[N1; ? ft1 MAHV 1 Nr 1 11111 '-: 1 `104 1906 1 966 1910 19 1: 30111 HPO l Ni f 1 F ftR 1'a 1.4 1 '116 114IH 19'A'0 1'1:'.' 19:'4 _ ? ,? t?, 3 ii,?t a 3 ?66 y p Permit No. Permit Holder Date Telephone # ELECTRIC PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL ,./ /?j/ BSMT R.I. BSMT FINAL DECK FTG DECK FINAL CITY OF EAGAN Addition D Lot p Blk Parcel 10 79()77 040 02 Owner Street /9a ?? a44?Q? State Improveme Date Amount Annual Years Payment ipt Date STREET SURF. 103, 1.986 9625.30 641.69 15 STREET RESTOR. 9 2 4 9 8 5 4 2 6 5. 57 16 4. 3 7 15 GRADING SS TRK 929 1985 282.70 85.51 15 SAN SEW TRUNK 105 1971 1 .38 87.97 20 SEWER LATERAL 1034 1986 2362. 157.49 15 Water Area 201 1977 128.84 8.59 1,0511, WATERMAIN r "00, WATER LATERAL 928 1985 2401 . 22 160-.,08,/ 15 WATER AREA 343 1977 533 . 5 2 3 5. 15 Spr Sriih.% 956 1985 01.77 56 .35 5 STORM SEW TRK 124 1970 489.22 9.57 STORM SEW LAT 1050 1986 1739.39 115.96 15 CURB & GUTTER SIDEWALK STREET LIGHT SS 1.,q t 19,97 f,929.63 365.9-3 5 . WATER CONN. BUILDING PER. SAC PARK /?7 yl 1986 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, i SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CER' 1 SET OF ENERGY CALCULATIONS COMMERCIAL OF SURVEY - CHECK WITH BLDG. DEPT.9 INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND To Be Used For: Valuation: /G+ p00 Date: &S /9 /i?,v /9 /904, "96 it /9w,191; Site Address 191S! /920_/9.72/roasd OFFICE USE ONLY Lot Al Block Parcel/Sub "cm C?y? 3?/10/?f/oiJ Owner Wu Address ege9 ///eJ '? Jel ? ?a0f City/Zip Code fd/.?lg, JI%/Dd SS?H3Sr Phone .93s s- ezs Contractor i1/e_ .Qup d Address W09 *) 71,4'&1 SOS City/Zip Code f? 11AW s"S S Phone .835 -377_ Arch./Engr. Address //vP.-I W P41, /0 ,fj4 . V, City/Zip Code ,yam/ , 291W /1li lss-- 4p Phone n Erect Remodel Occupancy Zoning kl/ Afl 'q 3) Repair Type of Const ?? Addition 11 of Stories Move Length /dam Demolish Depth 11?._ Int.Impr. Sq Ft Install APPROVALS FEES Assessments Permit 17Q Water/Sewer Surcharge .. -: 3/ >" P-)_ Police Plan Review f,(421 50 Fire SAC OU Engr Water Conn Planner Water Meter Council Road Unit 3 U Bldg Off Treatment Pl r7? - APC Parks /a Variance Copies TOTAL 6 NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. OWNER: SITE ADI CONTRACTOR: Aye- 9.1-a ,(&DATE: PHONE: 8.?S-.j77,3 Determine working square footage of each: 1. Total exposed wall area .. 2 sq. ft. x . 11 = ? I3 3 2. Total roof/ceiling area .. 14 e9O fA-l _ sq. ft.. x .026 Total exposed wail area above floor = R,? 92 a. Total wall window area ............................ 42-2-- b. Total door area ................................... 1IR6 c. Total sliding glass area .......................... y,6 d. Total fireplace wall area ......................... e. Total wall framing area (average 10%) ............. FS Dy f. Total net wall area above floor ................... 72310 g. Total rim joist area ............................. 1c 71<' Total exposed foundation area = 15:2 h. Total foundation window area ....................... i. Total net foundation area above grade .............. /S2 Determine out value of each wall segment: a. 03?2 x lug 3? = .201a.2 b. &8o x out Dd?4 = 33. / ?4 = Z3S. 2 C. 14,96 x out d. x out e &W X lug f. 9. 23/e x out Ot! 7 = 3 lO. / _ ------- 9. G 7S x SUN O-V 7 = 3/. 7 h. X out _ i . /5,2 x ' U' 3 . ................................................... Total If item 93 is the same as or less than item 41, you have met the intent o SBC 6006(c)2. Total exposed roof/ceiling area = /9 e94{-?l J. Total skylight area ............................... ?!o k. Total roof/ceiling framing area (average 10%) ..... / 000 1. Total net insulated roof/ceiling area .............. 9,199 4/ 411#4 (OVER) CITY OF EAGAN ' EXTERIOR ENVELOPE AVERAGE 'U' COMPUTATION / ?,4? Determine 'U' value for each roof/ceiling segment: i . . c / / ? x ' u s sfp = /8. 1. 998 x 'u' 49A4 4 . ...................................................... Total = ?. If total of 04 is the same as or less than 02, you have met the inten of SBC 6006(c) 1. Alternate Building Envelope Design To utilize the total envelope system method, the values established by the sum of Items S3 and 04 shall not be greater than the sum of Item4-?7 and 02. 1. /,/659 + 2. 3. RY?, 7 + 4. a?G• ?! _ CITY OF EAGAN 3830 PILOT KNOB RD - 65122 IS444 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 Remodel/Repair Reaulrements ? 3 registered site surveys ? 2 copies of plan ? 2 copies of plans (include beam b window sixes; poured Md. design; etc.) # 2 site surveys (exterior additions 6 decks) ? 1 energy calculations ? 1 energy calculations for heated additions ? 3 copies of tree preservation plan If M platted after 7/7/93 required yes _ No -7 5' `? 6 a s, DATE: 72 I ) f CONSTRUCTION COST: (,! DESCRIPTION OF WORK: STREET ADDRESS: r 7 ud LOT BLOCK SUBD./P.I.D. #: w PROPERTY Name: III &I 1 -1 OWNER _ Street Address' ? City: I C klkl uLAI Phone #: r&) '097 State: W C14&, zip, cj ? zz CONTRACTOR Company: 6?l?//'l'Sre -1 Phone #: Street Address: 9go oc_ License #• ( 7? 6 City: 6-old-CL 4 ou `e, State: mac- -1 Zip. 55qa ARCHITECT/ Company: Phone #- ENGINEER Name: Registration #, Street Address* City: State: Zip: Sewer 8 water licensed plumber: change are requested once permit is issued. Penalty applies when address change and lot hereby acknowledge that I have read this application and state that the 7M4 is C07 c and agree t comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: Pd OFFICE USE ONLY Certificates of Survey Received Yes Tree Preservation Plan Received Yes No No CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION mur;.?: PAYMENT' CIF FEE AT TIME OF APPLICATION DOES NOT L'OI1S`TITUTE APPROVAL OF PERMIT. INSPEClZ(k7 OF SEWER AMID/OR WATER INSTALLATIONS WILL NOT BE SCHED- ULED UNTIL PERMIT.HAS BEEN APPROVED. ------------ (Please Print 1) PROPERTY ADDRESS: DpXowm ek- LEGAL DESCRIPTION: oc or Tax Parce IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: (Mon Year PRESENT ZONING/PROPOSED USE: ? COMNERCIAL/RBTAIL/OFFICE ? INDUSTRIAL INSTITUTIONAL/GOVERNMENT R-1 SINGLE FAMILY R-2 DUPLEX (Two Units) 3 TOWNHOUSE (Three + Units) ( Units) ©/R-4 APARTMENT/CONDOMINIUM (_,6?LUnitS) 2) NAM: '46- ADDRESS: 0 ?Ag ,A- IF C CITY, STATE, ZIP: 'L. PHONE:_ q S' - / -z r 3) u i:: • l NAME: For City Use s 61 f j l D U Plumbers License: ADDRESS: Active CITY, STATE, ZIP: Expired Not recorded PRONE: MASTER LICENSE# St' t{??tyal 77 4) C?? NAME: ADDRESS: CITY, STATE, ZIP: %? (? v¢ ( 4/ PHONE: -5) n v as in •: :a Ry - 7I Er-CONNECTION TO CITY SEWER E,]-'CONNECTION TO CITY WATER OTHER 6) . i, ? 7) r n u• • PLEASE HOLD APPROVED PERMIT PLEASE MAIL APPROVED PERMIT 4 ('- O', UP BY ONE OF ABOVE,-?QW 3, 4, ABOVE yp?^r r ,?I e one) ll FOR CITY USE ONLY PERMIT # ISSUED 7 // zk Pd W/Bldg. Permit FEES: $ $ /D- 5-0 SEWER PERMIT (INCLUDE SURCHARGE) $ $ ?tJ WATER PERMIT (INCLUDE SURCHARGE) $ $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ ACCOUNT DEPOSIT - SEWER $ $ ACCOUNT DEPOSIT - WATER / $ ?? o a 0, U O $ WAC $ C-z' - ?? $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER $ $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ $ 'CL1 TOTAL RECEIPT RECEIPT DOES UTILITY CONNEC TION REQUIRE EXCA VATION IN PUBLIC RIGHT OF WAY? Q YES IF YES, THEN A " PERMIT FOR WORK WITHIN PUBLIC NO Q ROADWAY" MUST BE DIVISION LIST ISSUED BY THE ENGINEERING . AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE : Q 7/ Z C? /)/ f