4684 Stavern Pt `` `Kends. N aZ PERM I
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Sise'Addras: 4684 Stavern Point L4 B6 i idgec7,iffe III
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Meter No.: netlioa charge: 3 05.00 .pd.
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Sok ._ Account Deposit:
Render: No.: Permit Fee: 10.00 nd
I'spite Wiroloply wait NN tai of mew So tl,arge: . 50 pd
Misc. {larger: 60.00 pd meter
Tota
By Date Paid:
Dote of Insp.: irey
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4E84 5tavern Point I4 136 ;'idgeelitte
Situ Address:
phimber. Gen Ryan
L /P/80 20369 100.00 gd
I agree t su,i, *Ilk the ter of %IWO Connection Marge: 4 2 5.00 Pd
Oriiimmees. Account' t' Deposit:
Permit Fee: 10. pd
Surcharge: . pd
By 7 Misc. Charges:
Dote of 1 ��' Total:
insp.: /) ` / . - . Data Paid:
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Use BLUE or BLACK Ink
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For Office Use
} f Permit L/?55
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City of Eapn I Permit Fee: a 50
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff: ^ I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ~D l Site Address: q 6C-41' Unit
i Name:~496-ectj-ppe is ,6z_ E Phone:
Resident/ JgZ s
Owner Address / City / Zip: lqf 1..- 'L 1 e~ 14 2-,/
Applicant is: Owner Contractor
Type of Work Description of work: y e -,;-6&
I Construction Cost: *~Lr0 U O Multi-Family Building: (Yes / No
Company: r/I l4lg o `lax 1/'I~ Contact: 7t
Contractor Address: l G hel~~ _ City: Aoa0 4
State: Zip: Phone:
License 42 3 S'-O 611, 7 Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
F
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
. w~
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of I
the information may be classified as non-public if you provide specific reasons that would permit the City to it
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call 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.aooherstateonecall.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.
Exterior 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 7)1-* 1"',
Applicant's Printed ame cant's Signature
Page 1 of 3
Use BWE or BLACK Ink
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I For Office Use �
� � Permit#: � ,J� � I
�lt� Of ����Il � //� a � �
� Permit Fee: d lJ� �
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: I
I I
2015 RESIDENTIAL BUILDING PERIMIT APPLICATION
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Date: Z T Site Address: �L��p� '�v�°r'f'! /"F" Unit#:
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� � �
'� ' � ��'��'�� � Name:�G�`Q�L P�p+ ���� Phone:
Res�dent/
�� W�jjg� � Address/City/Zip:
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,a.: ������;�:�
� �;� ���'���� � a ,���� Applicant is: Owner Contractor �
� � �
µ � �� �� � l
� � Description of work: '���h -r1
Type.�of Wor :
�����`�`'��� Construction Cost: ���b Multi-Famil Buildin Yes /No
,�.,_. � ,: .�..._�: Y 9�( � )
"'������ �� � L�,_ �, �-n r7
' � �� Company: �/'���Yl. �7[L�t�- _`�ir yN Contact:�yt. �'yl��len
���� � —
� ��4� $��D �""" ��:�ct GG��-
� ���;�k �� � Address: City: �
� �Gontractor� —
� ��� � � 5 K 3� _��. �09
�� � �� ', State�/n Zip: �S Phone Emaii:
� �� �= ^,,
`�� ` � � - License#:/v��O�I'�I� Lead Certificate#:
,��.. ;
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTIIVG A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan 6�ased on a master plan?
_Yes _No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
x � � ��� �•�
�; �NO�TE P/ans and�suPpar#�ng al'acume�nts f af�ou sub►rr��`arQ ca,�s�dei�e�d to�be{` �r�it�c�nfot�r►a on �Pot#o,txs o�
th�rnforinaf�Qn�may�`be c�ass��ed as�no -publ���you rar�afe`spe�r��� .eas� ���at a��d� �#�he�Cify � � ,
� ��� �. ,
�,� .E. ; . r.-��:` �, =a�������, �������,:.;;� oncluale�thafthey�re radersecret � �� �;
r
CALL BEFORE YOU DIG. Call 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.qoqherstateonecall.orq
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.
Exterior work authorized by a building permit issued in accordance with the Minnesota S1:ate Building Code must be completed within 180
days of ermit issuance.
x �`��-- x
Applic nYs Printed Nam Ap icant's ature
Page 1 of 3