1296 Deercliff Lane
Use or BLACK ink
I
I For Office Use -
a its,
I I?ermil u C
ut of Eap ix"
:
t Permit Fee (s~ J
3830 Pilot Knob Road ?
Eagan MN 55122 Date Receved:
Phone: (651) 675.5675 q'7 ;
Fax: (651) 675-5684 staff: (
i
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 1 ~j Site Address:. x.90 -q Z 94-96 Z'Pfh4c-WZAQ e unit
Name: 1 Y Ta:~tJ AZG,j ,Phone: ~~t ! f-z
Resident/
Owner Address i City I Zip:. Q . Q2n~ at - -`Z 177 M.& j
Applicant is: Owner Contractor
Type of Work Description of work: ~~c? --P"a n
Construction Cost: f t ti Multi-Family Building: (Yes ~ f Na
Company: A bn ty'o Ao U!& k Contact: ! u c, n on)
Contractor Address; 9 2_0 CU e r1d 7rgy~ t ~ City: 0AG A.NL
State: - zip. 52. ~3 Phone: I~ 1 ?I -2-i G ) { (6 y
License Lead Certificate #:-A ) R 1
If the project is exempt from lead certification, please explain `,vhy: (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 R Water Contractor: Phone:
NOTE: Plants 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 speck reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-4002 for protection against underground utility damage. Call 48 hours
before you =nterid to dig to receive locates of underground utilities
I hereby ack mvledge that this inforrnat>on is complete and accurate, that the work will be in conformance with the ordinances and codes of the City of
f-.agan. ttvil I understand this is nol a pofmit, :rst only an appl!cation for a permit; and work is not to start wilhoul a permit. tnat the work twi; 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 184
days of permit Issuance.
Applicant's P ' ted Name Applicant's ignature
Use A*or BLACK Ink
Far Mos Use 1
i
Pernata I4/. *1‘000 1
4iiii.
t'.ity lA
3830 Pilot Knob Road ` /�1 v�
C/ , �
Eagan MN 55122 Date Received: / j
Phone:(651)675.5675 RECEIVED i
Fax:(651)675.5694 Stem
JUN 2 1 2017 ,..._..__ ...
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: (e 1 LI 117 Site Address: 1 2 91 11) e.H —LI_ £_j' • unit 9c.
Norm: �t u p Cv+-C` 117 W ry 1\--c r°n.e. A-C s c}e..i A bane: ,1-1 ---`i C 9 - T-1'.
ReOl f -r 4.v Gw,PC-
miner f Address/City 1 Zi P,:t ‘ eAlC 1:$.7 f t" -c e
I Applicant is: Owner 'C Cir OP
'1` > i Crtptstn of work: -42.N(. c w " i-Oa��t i, Dei C.
Construction cost Mut5-Fanny Building:.('Yes /No )
Company_ A\a4 v' contact'Dot, R te- #)
Address: 9. Z.0 a Y 'k- .L C : E ry ' '
ontractor
state rAP(.20: 5S—I 1-*-1) Phone: ►1/2.-91(2-1 it ` ? R t p p er+v L l ry
t ua : Q 4 Load Cotifi # ,; : t-- -- S J 911 _ Z
ifthe project is exempt from lead certification. . y
COMPLETETHIS AREA ONLY W CONSTRUCTING A NEW BUILDING
in the last.42thst ,has the City of Eagan issued a permitter a similar planbasedon a rbc plan?
Yes No ityes,date and address of Mester plan:
Licensed Phenbar: Phone:
Mechanical Contractor: Phone:
1 Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone: I
IVOTEZ ' St 'JpstMIOM , OW'asset/wharf consWered to bets** ., lS of
the Worm/goo may be classitotias nowptirMic give ode*prate natant;thatafauldpem*the CAy to
0000hitie-that , are#tit secrets.
CALL giEFORE YOU DIG. to Gopher State One can at(6511 for mon against underground utility damage. Call 48 hours
before you intend to dig to receive iocdtes of underground utilities. wwornocherstateonecatont
I herby adiriovoledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes ot tha City of
Eagan;that I understand This is not a permit,but only an appficatkm far a permit.end-wrak is not insert-wit a permit;that the work wS be
accordance with the approved plan In the case of work width requires a review and approval of plans.
Exterior work authorized bye building permit issued in accordance with the Mlnnesota State Building Code must be completed within lee
days of permit issuance.
x 1Jt3 u C; L,f5 R ,v r 'r i x g a' - ,''�
Applicant's Printed Name oatnt tire v a
Page 1 of 3
DO NOT WRITE BELOW THIS LINE 1 Lf-3 7C c
SUB TYPES /2 9(° (eQ.L.C,Li c- Lr'
_ Foundation _ Fireplace — Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration(Multi)
— Multi 74 Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of_ Plex _ Lower Level _ Pool _ Accessory Building
—
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building*
Addition ------ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
y0 Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation - a, see) ;' Occupancy Rc. -3 MCES System
Plan Review Code Edition iyir)Loi y– SAC Units
(25%_ 100% ) Zoning PD City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction \)3 Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings(Addition) _ ' Final/No C.O. Required
Foundation HVAC_Gas Service Test Gas Line Air Test
Roof: Ice&Water _Final Pool:_Footings Air/Gas Tests Final
Framing Drain Tile
_ Fireplace:_Rough In Air Test _Final Siding:_Stucco Lath __Stone Lath Brick
Insulation Windows
_ Sheathing Retaining Wall:_Footings—Backfill_Final
_ Sheetrock Radon Control
Fire Walls Fire Suppression: Rough In Final
—
— Braced Walls Erosion Control
—
�^ Other:
`
Reviewed By: t7 WI PTl ‘C-1-1 j , Building Inspector
RESIDENTIAL FEES �� t
Base Fee 1 `q x a b S7• s�
Surcharge #i C• aQ 5 g •
Plan Review
MCES SAC
City SAC 1. /d Sc> .
Utility Connection Charge
S&W Permit&Surcharge (-1)
Treatment Plant m i n i M 01v � Fee a., D ae•
Copies
TOTAL
Page 2 of 3
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