3776 Burgundy Dr
&~d Use BLUE or BLACK Ink
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Permit _
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City of Ea
I Permit Fee:
3830 Pilot Knob Road I • ~°f ~L I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 I Staff:
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:
Site Address: 77- "377 7e Unit
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Name: S~c_/7 eecr 4ejc3 c s- Phone:
I Resident/
Owner Address/ City/ Z2M ml 775___37A6 A,-
Applicant is: Owner Contractor
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Type of Work Description of work:
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Construction Co-st: Multi-Family Building: (Yes / No
Company: 42///x' ~(~Y/7~ /~j~hCrP Contact: ,ll/ llf
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i Contractor Address:Qkv .S'v~ S'✓ S0 9SO City: IS'
State: Zip: S.T! ~11 Phone: / ra2 - T 9/- 84609
License 0C 94924yl Lead Certificate #:WO7 - 3791a -J
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
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In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
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_Yes No If yes, date and address of master plan:
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Licensed Plumber: Phone:
Mechanical Contractor: Phone:
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Sewer & Water Contractor: Phone:
i 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 the 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.
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Applicant's Printed Name Applicant' Sign ire
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA119712
Date Issued:12/13/2013
Permit Category:ePermit
Site Address: 3776 Burgundy Dr
Lot:1 Block: 13 Addition: Seneca Hills
PID:10-67125-13-010
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.
Andrea Preusse
4145 Sibley Memorial Hwy
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 -
Mary S Angelo
3776 Burgundy Dr
Eagan MN 55122--316
(651) 332-1163
Wenzel Heating & Air Conditioning
4145 Sibley Memorial Hwy
Eagan MN 55122
(651) 894-9898
Applicant/Permitee: Signature Issued By: Signature