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3770 Golden Hill Ter
VILLAGE OF 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: I agree to comply with the Village of Eagan Surcharge: Ordinances. Misc. Charges: Total: By Date Paid: Date of Insp.• Insp.: VILLAGE OF EAGAN SEWER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber: I agree to comply with the Village of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: Surcharge: B y : Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: 3 bb, 31 to a, 37 c~ 4, 3 b co 3~ f~ $ l 3~~ a (210 d6 QM Wlkk -T-OX Use BLUE or BLACK Ink Far Office Use l I I g 353 ' Permit#: City of Ea~UR l Permit Fee: 1 3830 Pilot Knob Road t Date Received: d sq I Eagan MN 55122 Phone: (651) 675-5675 I Fax: (651) 675-5694 1fi 1 I L tW 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 6;6tdN TCrrQiG~ Date: ko r_Z`l" 13 Site Address: 3760 7 37U°~ 7GrG 37Vg 37>O UnitM Name: Phone: Resident/ t i Owner Address / City / Zip; f Applicant is: Owner Contractor Description of work: ® Type of Work ° Multi-Family Building: (Yes / No Construction Cost: 71 5 1. Q ©O Company: 't- ~tcltvt~r¢c.4J ~~R ns~Vcriv^•- --Contact: t &0 City: (r + + ~ i+ne lka~,l~m- E Address: Contractor i State: 01 A) zip: ~3`43 Phone: I # License f#:L Lead Certificate !MT' If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) S - ~ . t_cJ A- - /A w-4 ~Je- COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issueda 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.^Pottions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. r _ 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. 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 Cade must be completed within 180 days of permit issuance. Applicant's Printed Name Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA123432 Date Issued:06/06/2014 Permit Category:ePermit Site Address: 3770 Golden Hill Ter Lot:6 Block: 08 Addition: Town View 1st PID:10-77100-08-060 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Janel Behrends 122 West 3rd S 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 - Joyce A Totall 3770 Golden Hill Ter Eagan MN 55122 Haley Comfort Systems 122 West 3rd St Hastings MN 55033 (651) 437-0338 Applicant/Permitee: Signature Issued By: Signature