3841 Country Creek Way
Use BLUE or BLACK Ink
F---------------
I For Office Use I
Permit#:
City of Eat(t
Permit Fee.
3830 Pilot Knob Road 1 ~3
t ;
Eagan MN 55122 ; Date Received:
11
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 1 Staff: 1
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: / T 13 Site Address: Unit M
Name: 4 Ck `''l fSe ~Ql G' ~ Phone: a
Resident/
Owner Address / City / Zip:` ~GLP~LcGc /mil
Applicant is: Owner Contractor
CS av'
Type of Work Description of work: S
Construction Cost: o $ 41 Multi-Family Building: (Yes / No
Company:J e-4tN J 'D04 C~ 0nS'(i JtWZorJR "tact:
Contractor Address: 25/ (rO1n 57ZIL'1[- yir city:
State: 7nAf Zip: 53W,7 Phone: '74; -3 ' /657Zo
License M Lead Certificate M
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 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.oogherstateonecall.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.
x e 1,5- x
Applicant's Pri ted Name Applic is n re
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA166258
Date Issued:12/23/2020
Permit Category:ePermit
Site Address: 3841 Country Creek Way
Lot:9 Block: 2 Addition: Cedar Grove 11th
PID:10-16711-02-090
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 -
Richard & Denise Benedict
3841 Country Creek Way
Saint Paul MN 55122--165
Universal Windows Direct Twin Cities
150 88th St W #205
Bloomington MN 55420
(612) 866-2888
Applicant/Permitee: Signature Issued By: Signature