3821 Country Creek Way
Use BLUE or BLACK Ink
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I For Office Use I
City of Ea a~ I Permit#:
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I Permit Fee: I
3830 Pilot Knob Road 1 I
Eagan MN 55122 Date Received:
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Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 113 Site Address: Ce'"O~r GrV-~~ 642Z Unit
Name: -9a, A ~ Phone:
Resident/ -Q ~y /
Owner Address / City / Zip: 4 b CZ ~tr'IGf40- (a C Z 2 59 Applicant is: Owner Contractor
Description of work: b~Ql n
Type of Work
Construction Cost: Multi-Family Building: (Yes / No _X-)
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Company: #1140"C '(214 51 Contact:
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Address: City: [
Contractor /
State: l V Zip: (D Phone: - ;k = d ` j 8A
License ®O Lead Certificate
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 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 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
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 7i; State Building Code must be completed within 180
days of er tissuanc
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"~,ll'7 Appli ; nt r' ted a e an s ign ure
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA173042
Date Issued:10/26/2021
Permit Category:ePermit
Site Address: 3821 Country Creek Way
Lot:1 Block: 2 Addition: Cedar Grove 11th
PID:10-16711-02-010
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
Manh H Her
3821 Country Creek Way
Eagan MN 55122
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(641) 264-4088
Applicant/Permitee: Signature Issued By: Signature