4132 Ruby Lane
Sep 30 13 08:55a LS West, Ilc 9522368445 p.7
Use BLUE or BLACK Ink
I For Office Use t
My Permit: of Eap I ;
1 Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 Date Received: ;
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: 1
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: idlOt (3 Site Address: 2D 911-1, 4 IL LHle.- Unit:
1
Name:Wii 11~~~reW&45 dht) xl1ir~60 Phone:
Residentl
Owner Address / City / Zip:
Applicant is: Owner Contractor
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Type of Work Description of work l ^eAr- dl`
Construction Cost: J~ ~l 1 Multi-Family Building: (Yes ! No
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lie Company: Contact te &AJLrJ e
Contractor Address: 2e u~ keOtle- City: kd~g1ieJ
State: Zip: 5 U '7 Phone: LJt d ' ~71 -
License bU J L1 D .1 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 fora 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 dlg to receive locates of underground utilities. www.aooherstateonecall.ora
I hereby acknowledge that this information is complete and accurate; that the work will be In oonformance 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 B dldigg Code must be completed within 180
days of permit issuance. 91
x sit ti lN/! SL J.
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Applicant's Printed Name Applica s Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA152641
Date Issued:10/24/2018
Permit Category:ePermit
Site Address: 4132 Ruby Lane
Lot:250 Block: 03 Addition: Diffley Commons 2nd
PID:10-20451-03-250
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 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 -
Kenneth R Anderson
4132 Ruby Lane
Eagan MN 55122
(651) 365-1452
Schwantes Heating
6080 Oren Ave N
Stillwater MN 55082
(651) 439-3331
Applicant/Permitee: Signature Issued By: Signature