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3804 Heather Dr411' City of Emil 3630 Pilot Knob Road Eagan MN 55122 Phone: (551) 615.5675 Fax: (651) 675-6694 Use BLUE or BLACK Ink For Office Use t� Permits: i' 111 l Pernik Fee: _10 Date ReceNed: `I f (i `I `/ Y Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 11- -1 N Site Address: 3 o L/ 7;4 E. 7Z ©!Z • Unit #: ReiWent/ O cher Name: e/a Ilei M,e."; 46Ems ; C. phone:763 - s7%- 9770 Address / City / zip: S'SO D Z C 4,-u Q Avg AL o4 D E 14.LLS rr /OA) _ .r.r S/.t i Applicant is: Owner Contractor T!►I :Work, Description of work: ?L A c,t . m v L. .77 P I.E.,. L.)i..) 4e. (-3$ Construction Cost Multi-Famlly Building: (Yes / No _,, j • • Coirttaa%r • • Company: CI E i e)z- r £s / 0 2 /n4 -i a'r . LOI Contact. NA i..d r 6 a�a_gi s Address: 1/os' w rot" Sr- city: m Pt_ State: "3 3 Zip: 5-5- q/ 99 Phone: to/ 2. - 8 % / - Le 24'3 License #: 4-3 C• Vi/ / 7 1 Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional Information) CILe4,s. Q,,i,ti- Pos-- .57r .7...11•01. In the last 12 months, __Yes _No If Liconeed Plumber: 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, data and address of master plan: Phone: Mechanical Contractor Sewer & Water Phone: Phone: YCoNO Mr-II4t05 �nnector: l,y� / • ..'R Ql' 0101. ;:� ,�!!_OI'J'R;'jlflt" ' 0101 ' - 01 01« ii ' �� 0101 y`, y, ".' .• r+•r„ a CAL.t, BEFORE YOU DIG. Cap Gopher state One Call at (651) 464-0002 for protection against underground utility damage. CaII 48 hours before you Intend to dig to receive locates of underground udiltles. wwwaddherstateonecall,orq 1 hereby acknowledge that this info►maion is complete and accurate: that the work will be in conformance with the ordinances and codes of the City of Eagan; that 1 understand this Is nota permit. but only an application for a permit, and work is not to start without a permit: that the work IMP 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 Stats Build Coda must be completed within 180 days of permit issuance. x `V4v'0 ac./2-2iS Applicant's Printed Name - EZ/EZ 3JCd x Applicant's Signature Page 1 of 3 INIVW lX3 I3E L9Z9T98ZT9 LZ:bT tTOZ/TT/t'0 crtrN WATER SERVICE PERMIT '"�,-Knob Road. r PERMIT NO • 43" 55122 DATE 9 f? O f 2 RI1 No. of Units: 1 unit tn}ise Tollefson Builders er: Adder Site Address: 3804 Heather. rrive L2 B2 Briar Pill IV Plumber: Cenz P7en Meter No.• Connection Charge: Size Account Deposit. Reader No.: Permit Fee: 1s) 00 D3 Isom to comply wi o City of Eagan Surcharge. .50 pd Ordinances. Misc. Charges. 60.00 pd meter Total. By /is.i/ Date Paid. Date of 1 ., ! Insp • - 420.00 -p. !CITY OF EAGAN . \ 3795-Pitit Knob Ro ' PERMIT NO.: 5278 Eo -fan, A+SN 55122 ! I DATF• % u 2 No. of Units 1 unit tnhse Owner: Tolefson\'BuVIders Address. Site Address: 3864 Heather Drive 12 B2 2 Briar Hill IV Plumber Cet'CZ 17an-- ,9/9/82 31768 100.00 pd 1 agree to comply with the City of Eagan Connection Charge. 425.00 pd Ordinances. Account Deposit. SEWER SERVICE PERMIT Zoning: RI By Dat Insp . of Insp. Permit Fee. 10.00 pd Surcharge- .50 pd Misc. Charges: Total: Date Paid. �City o[Etat' 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675,5675 Fax: (651) 675-5694 Use BLUE or BLACK ink For Office Use t'4 3D3 Permit #: Permit Fee: p5-.15 Date Received: 10 / i (/ ( 3 Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: / 0— I ` /3 Site Address: 3 '1 ?° 114+ THEW DQ. Unit#: J Resit :, . Oilier -- r Name: d/o A C T M $ jj 4 4L At £J 7 T� C Phone: 7& - s'9 3 - 9"'70 Address / City 1 Zip: VS-C,ia E. 4.4 -7—u g /fit/ A3 A /9 &o >,E..1 (/ K«i' m•As -53-4,1 ,7 Applicant is: Owner Contractor TYPe Description of work: T £.42 OFA= a 2 E - Construction Cost /3 7O 01) Multi -Family Building: (Yes X' / No ____) Ca actor Company: CZE i £,e rc,2ioR 01,17,s7. . LP Contact: kiAvrde ."2R, f S Address: go S 103 4'D-11 S> - City: MPG $ ♦ State: /'%ici Zip: .3rV/ 9 Phone: G.",t - rb i - (2 1/3 License #: Age .t '/ii 3/ Lead Certificate #: If the project is exempt rctLD/os 1�£2t- from lead certification, please explain why: (see Page 3 for additional information) 11011.7- Pos" 1 517 Sr 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: N°77E: �/p�y/�1 j. The �i/!f �♦ i...ii/Yl/ • .. .. fi M• � ♦ Lt""ri' y �( v^�J . . .+ y "5 M . w 'i _.. Q �, #. 1 �• n ":S'ITlJ "t-'� *e. ' Yxt-'••i�y,.ai 2 (.,� t �aF�, tM .. Y 1 Q. " f•y . 1 - ➢i�•Y7TLy, ... a. .`�-• tl t Pr .� .. ;; ay, "w'�i,d.c,x:;d:s�,�` ,� -.�r.d„"�±1G.�.w,',Ca `�_ °� 1`' 'K'•,j.: , .�. .... .. � CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. CaI148 hours before you intend to dig to receive locates of underground utilities. www.aooherstateonecall.ora 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 Buildi days of it n� Code must be completed within 180 x AviN (Ivadz f_s Applicants Printed Name x Applicants Signature Page 1 of 3 *City otkap 3830 Pilot Knob Road Eagan MN 68122 Phone: (651) 6756676 Fax: (651) 675.6684 Use BLUE or BLACK Ink For Office Use tr>3 Permit 4: 2� Permit Fee: Date Received: Staff, 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: A -17-1V Site Address: "1/II, 3 ° /, 3 god, Sog z i4ThN2'Z 6 12.. Unit 0: Re$ident! Owner Name: e /O ,1 c % iThe AI 4 6 .I C.- Address! . - Address! City / Zip: SSo D C.44 T U R. 4V. i3 Applicant is: Owner Contractor Phone: 76 3- S-7 3- 9 7 7 (pOLi�EA :� LY /?A Yype:of,Work. Contractor w••• Ss 1/t 7 Description of work: R>; - c ' a. R z PL 1Kf.- 1' 't AS L 7-4 L. Construction Cost: 14. Y Uu • W Multi -Family Building: (Yesi<. / No Company: £ 1 cf* r X 02 /AO aT . Galt Contact: 640r 0 4..,2QdS Address: 4/19SL lobi' S: , state: /VAS Zip: 5r4/1 rj License a: L 2 Y/ / 3 / City: mPLS Phone: I0i2.' g41/ -402V3 Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) SLalpS. PoSr' /5"77 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? Yes No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTEp....:,��P{�i,.l.l. f..i,S�/�a�ns the�Infosma Ion.7 dOciarOlgli -000800/04-60014*. as noo pflMdo specpc'ireason* d' tawL�J� ��Ji1�ilA.. '3 ). .... •..;'. , p14[ CALL BEFORE YOU DIG. Call Gopher State One CaII at (651) 454-0002 for protection against underground utility damage. CaII 48 hours before you intend to dig to receive locates of underground utilities. www.siooherstateonacall,ora 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 1 understand thie 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 whim requires a review and approval of plans. exterior work authorized by a building permit issued in accordance with the Minnesota State Build nLCode must be completed within 180 days or permit issuance. x I) Rya -Cr f Applicant's Printed Name Z0/Z0 3E d x. Applicant's Signature Page 1 of 3 1NICW 1X3 I3S L9Z9T98ZT9 Sty:ST UTOZ/6T/Z0