1921 Gold TrCITY OF EAGAN
3795 Pilottk£nob Road PERMIT NO •
Eagpn, MN 55122 DATE -
Zoning: No. of Units.
Owner:
Address:
Site Address.
Plumber:
Meter No • Connection Charge•
Size: Account Deposit•
Reader No.: Permit Fee.
I agree to comply with the City of Eagan Surcharge•
WATER SERVICE PERMIT
Ordinances.
By _ S44-27"Date Paid.
Date of Insp.: TZ._ Insp.:
Misc. Charges:
Total.
SEWER SERVICE PERMIT
CITY OF EAGAN
3795 VI*, Knob Road PERMIT NO.:
Eagan,
MN 55122 DATE:
Zoning: -- No. of Units:
Owner:
Address:
Site Address. —
Plumber:
I agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By
Misc. Charges: —
Date of Insp.: Total:
I nsp.: Date Paid:
City of Ea�all
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
i- 71777-
J(7- 21,1, ,
Use BLUE or BLACK Ink
For Office Use
1 I5c 7S
Permit #:
Permit Fee: 5 l
Date Received: //c)5//3
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
L_,
Date: 5/ /3 Site Address: 3 8"S 3 9 S 1 b Lo yst #7-E Q k .
Unit #:
Type of Work
Contractor
Name: L/n
Phone: 76 -s 3 - 9 � 7 0
Address / City / Zip: 'S' h fo c +4 '3'—rJ ,Q fq,, cla
m-43 s'3'4'.7
Applicant is: Owner is Contractor
Description of work: T"EA-a C7-;1=
Construction Cost: /3. 7 Or' -°-.° Multi -Family Building: (Yes )C / No )
Company: cSL / £ "T£1L/Die eJ Contact: f2R r
Address: 90 s VI:" S"T . City: PL S .
State: IPJ Zip: 5s'9/ 9 Phone: to `2 ' s76/— .2 113
License #: / / Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
L E 2L Pos / 4 757
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 maybe classified as non-public if you provide specific reasons that would penult 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.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 Buildin Code must be completed within 180
days of permit issuance.
x AL/ v21t3
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3
4,1`City otEgli
3830 PUot Knob Road
Eagan MN 66122
Phone: (651) 6754675
Fax: (651) 675.6894
Use BLUE or BLACK Ink
For Mice Use
Pem,rttt_11 ')-61`(
Permit Fee: �'" :°
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 3 y- / 4' site Address: /121 r• f . GoLi) J3f3. lot -0 nr r -r fie- Unit if:
Phone: 743 - S'% 3– 9 7 7 0
Re&dertt!
Owner
Name: ejo 4e 4 e 0.4ki c,
Address/City/Zip: 8S0 tYVft A✓, A), 2A 6oc.D£,J 1/441,sY /t,J
Ss itel 7
Applicant is: — Owner kConbractor
Type •of Woric,
Description of work: IZ£As-o E a. RE Pc 4-C.L. 1' `' 6 d Fes" a fr E —4 L
Constmcdon Cost /14 41‘70. CrO
Corotrratitor
Multi -Family Budding: (Yes X / No )
Company: a E. I £,e. n /Z MAI if. Lp RA, Contact b4 (Lad S
Address: 4/os' GJ [poo�� , city: m PL S
State: /1?0 Zip: Sr "q
Phone: Lo/.t• 86/-6o2V3
License*: 'S - Z 4/1 / / Lead Certificate*:
If the project Is exempt from lead certification, please explain why: (see Page 3 for additional information)
t�e.ta�S- I i�r Peso iv7r
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW itUILDING
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
thq Rete mseaon.
CALL BEFO -
before you
YOU 019. Can Gopher Stats One Call at 051)46440M for protection against underground utility damage. Call s8 hours
to dig to receive locates of underground utilities. rvww•aosharotateonaralt.orq
I hereby acknowledge that this information is complete and emirate; that the work will be in =romance with the ordinances and codes of the City of
Gegen; that I undwat end this Is not a ;remitbut 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 authorised by a building permit Issued In accordance with the Minnesota Stale BuitditrLCode must be completed within 180
days of permit Issuance.
x i2i.'a. zit
Applicant Printed Name
90/50 39 d
x.
Applicant': Signahlre
77,,
Page 1 of 3
1NIt7W 1X3 I3S L9Z9T98ZT9 SG:TT bTOZ/bZ/60
City of Eagan
PERMIT
City of Eaan
Permit Type: Plumbing
Permit Number: EA124230
Date Issued: 06/25/2014
Permit Category: ePermit
Site Address: 1921 Gold Tr
Lot: 2 Block: 01 Addition: Briar Hill 3rd
PID: 10-14992-01-020
Use:
Description:
Sub Type: Residential
Work Type: Replace
Description: Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Tony Boerner
2090 County Road 42 W
Burnsville, MN 55337
Fee Summary:
PL - Permit Fee (WS &/or WH) $55.00
Surcharge -Fixed $5.00
0801.4087
9001.2195
Total: $60.00
Contractor:
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
- Applicant -
Owner:
Marcia Ann Johnson
1921 Gold Tr
Eagan MN 55122
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.
Applicant/Permitee: Signature
Issued By: Signature