1002 Trillium Ct -Permit and zoning app
Use BLUE or BLACK Ink
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~ Permit r) 1.1
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City of ~
I Permit Fee:
3830 Pilot Knob Road I 1
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
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Fax: (651) 675-5694 I Staff: I
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: d Site Address: /400Unit
on
Name: Phone: ~T - Q,/
Resident/
Owner I Address / City / Zip: 19940 00
Applicant is Owner elContractor
Type of Work Description of work: -ge..I'-eg X060 /~iG ~ral® t
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F Construction Cost: Multi-Family Building: (Yes /No
Company: 16' P Ae-e-1 b el Contact:
Contractor Address: 30 //~,~e. 410 City: ~ot4)0-oa-~
State: lL Zip: 41617 1- Phone: (a day .6~r yo
f License Lead Certificate 47 _
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
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 documen#s_ that you submit are considered to be public information. Portlons of
the information may be classified as non-public if you provide specific reasons that would permit the City to
- conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
1 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.
x &m4- X 44- 00!~,
Applicant's Printed Name Ap icant's S' nature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation _ Fireplace s Porch (3-Season) _ Storm Damage
_ Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
Multi _ Deck _ Porch (Screen/Gazebo/Pergola) Exterior Alteration (Multi)
_ 01 of _ Plex _ Lower Level _ Pool _ Miscellaneous
Accessory Building
WORK TYPES
- New _ Interior Improvement - Siding _ Demolish Building*
- Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
_ Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation Occupancy MCES System
Plan Review Code Edition SAC Units
(25%_ 100%Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction 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
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: - Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
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