4486B Clover Lane CITY OP EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.: 1 G
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
B Date Paid:
Date of G�L`� -7 7 O3 Insp.:
CITY OP EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road
Eagai, MN 55122 PERMIT NO.:
DATE:
Zoning:
Owne r:
-- No. of Units:
Address: — Site Address:
Plumber:
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
B Surcharge:
y — Misc. Charges:
Date of Insp.:
Total:
Insp.: Dote Paid:
From:ALLSTAR CONSTRUCTION 19529427464 09/1712013 08:54 #582 P.077/079
Use BLUE or BLACK Ink
For Office Use
Clt O!~ ~!1 !Permit # 1
I "a I
~ Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 j Date Received: 'L' 1 j
Phone: (651) 675-5675
1 I
Fax: (651) 675.5694 1 Staff: _
v
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: lit 2 0l _ Site Address:'-414,ggiHB1t- %,14g1A MXt 11L _Unit M
Name: _ Gleh C ~ 0: G aS Company Phone:
I Resident/ p. ,
Owner Address/City/Zip: US-61 VW p01Yk."r Et~lW Naly1C,M.N 5`r~~~ I
Applicant is: Owner Contractor
Type of Work Description of work: -I(XV off am
Construction Cost: ~Ig12po-Do Multi-Family Building: (Yes / No
Company: Agay Wadm fil LLE Contact: _ At
Address: VJ1% I ftal SfirN ~1f"3 City: MAW lifts
Contractor
state: _ Zip: EGaGol Phone: 952--
License m G7CWNC519 Lead Certificate Nft T-
10 L04 -0
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 pennit the City to
conclude that th y 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 of permit issuance.
11 X_ 14 o_L_;U1
Applicant's Prin d Name Applicant's Signature
y;
Page 1 of 3
From:ALLSTAR CONSTRUCTION 19529427464 10/21/2015 12:30 #269 P.015/020
Use B�tEE or BLRCK!nk
�-----------------
iFor OHice Use �
C)t �f c� c� j Permit#: J� �
.
1L� 1 Q�Q� � -3 �. �
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3830 Pilot Knob Road
RECE�VE � Permit Fee: �
Eagan MN 55122 OCT '� � ZQ��j � Date Received: �
Phone:(651)675-5675 � �
Fax: (651)675-5694 1 Staff: �
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2015 ��SI����I�L �E�EL�3iNG PEl���T�aPP�.ICATtOIN
Date: Site Address: Unit�!:
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' Name: t.�n�,�✓4: 1 t��3�e"s� ���e•t �d�F Phone: N�/g �
� Resident/ ,]� �
OWner � Address/City/Zip: c�7C/5�'���l�af � g'7� � �p-�°
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� � Applicant is: Owner � Contractor
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� Company:�I���Art �nS��t�t�,�r1 t/✓�/�a�tfi/!`��rc� Contact: �.,,�,m �Q il�..�.,� �
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Address: 7�ii/5 /n��'S�',�-,ro�L ��- - �;,,4,k�. /Q� City: �A �� ��t FF..� `
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State:�Zip; ��3�`� Phone: �2-5��2�'75/5��Email:_�n'��ct 1/�"�z 6". ��. �
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� If ihe projeci is exempt from lead certification, please explain why: ���L� �„� �c��� �
�
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� COMPLETE THIS AREA ONLY IF CONST'RUCTING A NEMI BUILDING ��� �
In the last 12 months,has the City of Eagan issued a permit for a simila�plan based on a master pla�? � '
� � �
� Yes No If yes,date and address of master plan: �
�
� Licensed Plumber: Phone: �
� � .
�� Mechanical Contractor; Phone:
Sewer 8 Water Cont�actor. Phone: �
�
� �
� Fire Suppression Contractor: Phone: �
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� NOTE:Plans and supporting documents lhat you submit are considered to be publfc inforn►ation. Portions of
..
the informafton may be classifred as non-publfc if you provide speciffc reasons that would permit!he City to �
� conc/ude that!he are trade secrets.
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CALL BEFORE YOU DIG. Call Gophe�5tate One Cali al(651)4540002 for protection against underground utility damage. Cell 48 hours
before you intend to dig to receive locates of underground utilities. www.aooherstateonecall.ora
I hereby acknowledge that ihis 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 bui(ding permit issued in accorda�ce with the Minnesota State Buiiding Code must be cor�pleted within 180
days of permit issuance. � ,.,,�_...._, �,,,.=
X -�:s;;�... ,�//��� X �'"~ ''"��" .�
Applicant's Prinied Alame �„Applic nt's Signature �
Page 1 of 3 -
e*i�
0
EAGAN
n
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
buildinginspections(a)cityofeagan.com
-------------I
For Office Use �y n/
I 1 Building Permit #: �Tl L,1J��j
I I
I
I S&W Permit #: I
Permit Fee:
I I
I I
Date Received: I
I I
I I
I Date Issued:
I---------------------J
RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Applicant is: ❑ Owner Contractor
Homeowner
Unit #:
Name:�ibyV,e—CDk As�5C�C'Ipt_4k C>
Address: CJ�/ ri 4k.Ii�d+v City:aQ 0.
Phone: Email:
Description of work: P,,, Q C,
Type of
Work Construction Cost
Type of building: ❑ Single Family ❑ Townhome, of units Twin Home
Compan :17QM t/t 't c.�_ o\� Contact:
Building Address:6 q B CA& UJP-<- - &� Y City:�GCP�
Contractor f/ '/s
5-k/ Phone6tz-J'f State:Wip:
License #: o ti Expiration Date:
Sewer &
Water
Contractor
Company:
Address:
Required for State: Zip: Phone: Email:
new construction
( License #: Expiration Date:
Contact:
City:
` 1 understand that Plumbing, Mechanical, and Fire Suppression work require separate applications.
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. Contact Gopher State One Call at (651) 454-0002 or www.gopherstateonecall.org for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
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.
�( ,0.V �2� 1�e--\C + x
Applicant's Printed Name A licant's Signature