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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