3850 Country Creek Way . Use BLUE or BLACK i �C, �
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' � Permit#: � ! j��.�
Clty of ����� � �� , �� �
� Permit Fee: �
3830 Pilot Knob Road
Eagan MN 55122 � Date Received: `�� /��
Phone: (651)675-5675 ������E� I I
Fax: (651)675-5694 Nav 2 3 20�5 i Staff�------------- i
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
f Name: ��'� � �'O N � Phone: �S�• ���.s/�j .2
R�sid�n�t 3 �O �v w, G .��
Qwy�g� Address/City/Zip: � � � � "v/�"�
Applicant is: Owner Contractor � �� �
T' � of y1�O1'1C Description of work: �^'-S�fi1�L �'���d/�j.7,�,¢-�'�'")"iL�C �,�'�4,,��'�
�� Construction Cost: j 6 �C�' P`
Muiti-Family Building: (Yes /No,�
Company:__(j. Cj.�f-k�J�� �o+rG,�'�i7v.� Contact: �/�'o�%�y— G���b��
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� �.t�r�ractQr
aaaress:_ ���6� o rt� r�s� ��� c�ty: S���G��
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' State: m� Zip: �53��/ Phone: �d�'�7� Email:
License#: ,aG-a-1�6� Lead Certificate#: �'� �U���" l
If the project is exempt from lead certification, please explain why:
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 m�ster plan?
Yes No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer 8�Water Contractor: Phone:
Fire Suppression Contractor: Phone:
' NOTE�#�fan�and��j�pc�rf��g tivcr�►�ents t�at ycru�ub�r�f�a�s��nsidered tr�be p�b�i�i�far�a�icrta. Aor��r���r�f
' tlae lnt'o"rmatfc�n�ay he cta�si�e�l,a�'�aor�-�ub�c i�',�ot�pro�i�e spe����c����hat inrr��ltl perrr��t f�e C�f;��a
ct�r�c�t��e l�t�ai't�ae are trade secre�s. , '
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.qopherstateonecall.orq
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.
j��N�/}'L L l���a�t=,� � .d._
x /
Applicant's Printed Name ApplicanYs Signature
Page 1 of 3
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���L� � � � V` �/��� DO NO�T WRITE BELOW THIS LINE �`7�C%� �
SUB TYPES
Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration (Single Family)
Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration (Multi)
ulti Deck Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of Plex Lower Level Pool _ Accessory Building
WORK TYPES
New Interior Improvement _ Siding _ Demolish Building*
Addition Move Building _ Reroof _ Demolish Interior
Alteration Fire Repair _ Windows _ Demolish Foundation
eplace _ Repair _ Egress Window _ Water Damage
Retaining Wall "Demolition of entire building—give PCA handout to applicant
DESCRIPTION r
Valuation �l� � Occupancy �,..���`���` MCES System
Plan Review Code Edition �� � SAC Units
(25°l0_ 100%�) Zoning _ ,�_ City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
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
Roof: Ice &Water Final Pool:_Footings _Air/Gas Tests _Final �
Framing � Drain Tile � j; �°"�.'�'��"�,,
Fireplace:_Rough In _Air Test _Final Siding: _Stucco Lath _Stone Lath _Brick
Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
�,_....
Other:
Reviewed By: � �' , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surchar e ' �''j �
9 �-� �� ,r �� t,�
Treatment Plant � � !
Copies
TOTAL
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