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1612 Clemson Dr B CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road P.O. Box 21199 _ PERMIT NO.: Eagan, 55121 DATE: Zoning: No. of Units: Owner: Address: Site Addess: Plumber: Meter No.: Connection Charge: Size: Account Deposit: Reader No.: Permit Fee: I agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: �/� �� Total: By "�� Date Paid: Date of Insp.: .;Wy Insp.: CITY OF EAGAN 3830 Pilot Knob Road SEWER SERVICE PERMIT P.O. Box 21199 Eagan, MN 55121 PERMIT NO .: Zoning: DATE: 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 ate B yte of Ins Misc. Charges: Date p.: Total: Date Paid: Ilia i��a 35/C PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA112016 Date Issued:07/23/2013 Permit Category:ePermit Site Address: 1602 Clemson Dr B Lot:59 Block: 01 Addition: Thomas Lake Heights 2nd PID:10-75951-01-590 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Stephanie Vought 3451 W Burnsville Parkway Suite 120 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 - Helen E Wiese 1602 Clemson Dr Unit B Eagan MN 55122--186 Burnsville Heating & Air Conditioning 3451 West Burnsville Parkway, Ste. 120 Burnsville MN 55337 (952) 894-0005 Applicant/Permitee: Signature Issued By: Signature 411) City of Eapil 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: (5/ / 3 Site Address: / 67102 , CL5/1.4Smw Unit #: Resident/ Owner Name: e //2 ---&'Phone: iirrC) `41,3. - 018 7 //� Address / City / Zip: /1,01,R0 c L&ri 4SO/t' &4, Co4GAzA 5 J. 3 Applicant is: Owner XC Contractor Type of Work Description of work: �/'{2£/2Ltt LC C7 -,N /2/I Z.-/S-poo(Z Construction Cost: 4/1/ O 0--c) Multi -Family Building: (Yes ?"'"/ No ) Contractor Company: /Lu//1/ 6*., al -71141114-6-2 °k' CGS Contact: S -/ELL. --E, ,c%%1� / i)/i�(. fi=r 67,-C) p Address:/ 23/C`v5 A-6--/1/, City: /0p/5 `, State: /�yi/c! Zip: -.5--17/...-1,e Phone: 9.;a? - 6 q%V` �, s2 - License #: L-3 ©"'SoD '6_ Lead Certificate #: fti' r - 7 4 5 7 3 - C If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 4''c L-ua D 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: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: 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.gonherstateonecall.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 State Building Code must be completed within 180 days of permit issuance. x c-te S7 dffil�i�y�. Applicant's Printed Name X Wit—`_ _ �� Applicant's Signature Page 1 of 3 Use BLUE or BLACK Ink For Office Use I ~j I nj Permit t City of EI Permit Fee: 3830 Pilot Knob Road I I f j .9 Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Staff: Fax: (651) 675-5694 I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 3 Site Address: o? 1,3 & IM 1 C 1eAs~ Y1e Unit Name: / I / _LLOILAO-S 4)~ Phone: Co.1a 7L/-7 -IS cat' / Resident/ Owner Address / City / Zip: )30UC Applicant is: Owner Contractor T tf/ ei 5Jjjjvi Description ofwork: e T ml Jr PDOC ;,~ff!J~e f /A? Ype of Work -i S d~ ConstructionCost: 1,~ i Company: " Contact: C13 q:), i_i r✓, C mte,, N 6 icy l Address: City: Contractor i Yk1✓1 State: Zip' Phone: -ticense # - ea e i icate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) I9+J < P dJ /Y r 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.aopherstateonecall.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 ate Building C de must be completed within 180 days of permit issuance. x 1sl~ S x Applicant's Printed Name Ap cant's Signature Page 1 of 3