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3870 Dolomite Dr4,1/ City of bin 3830 Pilot Knob Road Eagan MN 55122 Phone: (661) 6766676 Fax: (681) 67846694 Use BLUE or BLACK Ink Fro Otttce Use Petmit it: r 1-11, Pet: Ire -35 Date Recoiled: ► 1► Staff 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: t'/- 9- / / Site Address: 3 8 7 4- �'2'1-°011 r4 A - Reldsnt/ Owner Name: C/ 4e r %%%»vS 46ZNt E..; ..2. c. J Unite: Phone: 74 3- S 9 3— 9 7 7 o Address I City / Zip: :SO D is C r4 -r u 2 A✓, A %oL D S 1/ [.E S -4/t7 Applicant is: Owner 2f Contractor Type. of:WOrk, Dion of work: Q -P' 4 C2.. MO C Yi PC L 401-13 Construction Cost - Multi -Family Building: (Yes I No _) Cofactor Company. Cit r £r✓ c 2 TX 4T APT . Ce RP, Contact Da ✓ r �u/2-215 Address: L/oS L4' (oC �"• state: r7As zip:.sty/ q Licensee: 4 G VP/ 3I City: m PL S Phone: 4./2- 8 % i en z ei-3 Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) (11-e(as- Q' /Lr PoS j'-jr COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the Last 12 months, has the City of Eagan Issued a permit fora similar plan based on a master pian? _Yes No If yes, date and addreas of master plan: Licensed Plumber: Phone: Mechanical Contactor: phone: Sewer & Water Contractor: Phone: NOTrthe te,'!): you Core you AU.. EORF gOUto Due lord of mete one � at (651) 454.0002 for protection against underground utility damage. Call 46 hours underground uthldee, www.aonhentatoonocaU orrr I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the aifinances and codes of the City of Eagaann: e + t uthe na `a not a Oona$. but permit.permit. orilY an applioadon for a pe� and work is not to start withouta permit that the work we be in approv Wen in mw case of wax wrath requires a review and approvel or plane. Exterior work authorized by a building permit issued in accordance with OW Minnesota Stats Sulen Code must be completed within 150 days of permit issuance. x ii4✓'0 2u/4Z/I Applicanrs Printed Name 6I/60 39Cd Applicants Signature Page 1of$ 1NICW 1X3 I3S L9Z9I98Zt9 9T:bt btOZ/ZZ/b0 CITY OF EAGAN WATER SERVICE PERMIT 3795 Pilot Knob Rood 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. Total • By /s"j Dote Paid• Date of Insp.: /Cl .., I nsp • CITY OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 Zoning: Owner: Address: Site Address: Plumber: SEWER SERVICE PERMIT PERMIT NO.: DATE: No. of Units: 1 agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: B Surcharge: Y Misc. Charges: Dote of Insp.: Total: Insp.: Date Paid: 410'City otEke 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 678.4676 Fax: (651) 67566$4 Date; • Use BLUE or BLACK Ink imr For Office Use / Permit* l! ; / o0' hermit Fee: ;7. 4)55 Data Received: 11 /I 543 3 Staff: 4,! 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Site Address: 3nJ 3$70, le72,3?79 tSo4.ow,rz Aa. Unit#: Choler Name::/ u9 C 7- "4 A 4. Al t v i .x+) C Phony 743 - tS 3- 9 7 70 Address / City / zip: 7S-0 zr e A 7-v Q Av A) 'a` ,2 A aaoi b E.J i//K mss S3'ylr7 Applicant is: Owner Contractor Description of wont: • r.412 or -F2 a 1 L - Construction Cost 1/ 9 00, Gr° Multi -Family Building: (Yes )C / No Company i&! P Contest knew, Is TS. (J ' S address: 4/0 s tc) 64).6. S7 . City: m PG S . State:/Y%c 1 zip: .3T 9i 9 License #:.!0C .*Y!/3/ Phone: 4'11- r6' -G x Y3 Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) QtLi,I,S L L2( QuldY Porti' 197 S COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has Me City of Eagan Issued a pemnit for a similar plan based on a master plan? Yes No If yes, date and address of master plan: Licensed Plumber. Phone: Mechanical Contractor. Phone: Sewer & Water Contractor Phone: 1 CALL. BEFORE YQU DIG. Call Gopher State one Cali at (651) 454-0002 for prot cl on aga A$t underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.goaherstateonerau.org I hereby adcnowledge that this information is complete and accurate; that the work wit be In confom ante 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 to Mart without a permit that the woi t iota be in Beeordenne with the approved Wan In the case of work reach requires a review and approval of Exterior work dots of peckwitholted by a building permit Issued in accordance with the Minnesota State autldin Code must be computed within 180 x VAviN u a.i3 Applicant's pn Name Z0 / TO 39tid INIVW 1X3 I3a x Applicant. Signature 777 Page 1 of 3 L9Z9T98ZT9 OZ:ZT ETOZ/tT/TT 411INF City Date: 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 6755675 Fax: (651) 675-5694 FA 3--? _ Use BLUE or BLACK Ink For Office Use Permit #: )1, W Permit Fee: Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 7 4./ site Address: Mag, 3sg70 3771, 3¥ )4f 62. Unit 6: Resident/ Owner Type'of.Work, Name: eh) 4e, Aff,3 46t N<iA.3 + r Address / City iZip: :SO b1C34-r-u2 Av, , lA Applicant is: Owner KContractor Phone: 7k3 - si3- 97 7 oLD£:J V L Y /QA) spy. 7 Description of work: R£KO E a' 4.4 P °Kf - J,'' ',) /o 6 F Multi -Family Building: (Yes 2C / No Construction Cost / 4 Y • CN Contractor Company. g £ 1 E,r ER/ c 2 /Aft kr-r . &2� Contact Da✓, Address: YDS. w tDo# S- City: h'/ Pi 5 State: /VAS Zip: SS -y/ C/ Phone: 1pi ,Z ' b' (r' / - Lo 2 S/ 3 License It: 4 �- ZIP / 3 / Lead Certificate #: J If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) (11-4/0s. Pos,- /77r 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 pian? Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor. Sewer & Water Contractor: Phone: Phone: CALL BEFORE YOU DIG. Cap Gopher State One Cali at (651) 4540002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.000herstateonecap.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 1 understand this is not a pormit. 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 Build n Code must be completed within 180 days of permit issuance. x I./ Applicant's Printed Name x Applicant's Signature / 4',x77 �) Page 1 of 3