1533B Clemson Dr CITY 9F EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
Meter No.• Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges: _
Of P �*-+- Total:
By > Date Paid:
Date of Insp.: Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road
PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning:
Owner:
— No. of Units:
Address: — - - --
Site Address: —
Plumber: — — --
I agree to comply with the City of Eagan Connection Charge:
Ordinances.
Account Deposit:
Permit Fee:
By Surcharge:
Dote of Misc. Charges:
p.: Total:
Insp.:
Date Paid:
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3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I ~1~ I
Fax: (661) 676-5694 1 Staff: 7C 17 I
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- - - - - - - - - - - - - - - - J
12013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: G~ I C~ (J
y 1! I~~ V t y i f v t Unit M
Name: 1 C i o m o ~c' 4 f Xi sa ui lmhone: , G,K W c'
Resident/ 1 ~o V ~ f r`l
Owner Address / City / Zip: yy) ~G
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Applicant is: Owner Contractor
Type of Work Description of work: Q ~ G V16 VI VDr ~y
Construction Cost: 0 D Multi-Family Building: (Yes / 'No
Company: ~S~LA tlocc)~'L~t1c~ KEi71(x~L'~in4 o tact: ~`J e V 1
Contractor Address: gIC)G ~c~lslO~ ~JiUc~ City:, S4. Lock
State: PA 1A Z``ip: 5y ~O Phone: / o~
License a-(L o 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?
_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 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 (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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 o
i2 f permit issuance. ~j1
x t~ 1-11 S x
Applicant's Printed Name App ' is ig ature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA167069
Date Issued:02/22/2021
Permit Category:ePermit
Site Address: 1533 Clemson Dr
Lot:20 Block: 03 Addition: Thomas Lake Heights
PID:10-75950-03-200
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
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 -
Rosa M Ruiz Mendez
1533 Clemson Dr Unit A
Eagan MN 55122
Homeworks Services Co Dba Homeworks Plumbing Htg
1230 Eagan Industrial Rd, Suite 117
Eagan MN 55121
(612) 400-9020
Applicant/Permitee: Signature Issued By: Signature