EA183197 - Building - Reroof - Issued Date 05/26/2023 PERMIT
City of Eagan ® ® ® ® Permit Type: Building
3830 Pilot Knob Rd ®®®®® ®®®® Permit Number: EA183197
Eagan,MN 55122 EAGAN
(651)675-5675 111111111111
www.cityofeagan.com * E R 1 8 3 1 9 7
Date Issued: 5/26/2023
Site Address: 1273 Carlson Lake Lane
Lot: 006 Block: 005 Addition: Wilderness Run 4th
PID:10-84353-05-060
Use: * 10 - 84353 - 05 - 060 *
Description:
Sub Type: Reroof Construction Type:
Work Type: Replace
Description:
Census Code: - Occupancy:
Zoning:
Square Feet: 0
Comments: Please print pictures of ice and water protection and leave on site.
If water damage is encountered,please call(651)675-5675 to schedule a site visit to verify the extent of the damage.Any
repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair t:
water damage.
Fee Summary: BL-Base Fee $133.15 0801.4085
Valuation: 5,000.00 Surcharge-Based on Valuation $2.50 9001.2195
Total: $135.65
Contractor: - Applicant - Owner:
Hmong Roofing&Siding Bo Thao
5870 Woodlane Dr 1273 Carlson Lake Ln
Woodbury MN 55129 Eagan MN 55123-476
(651)497-5788
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
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.
Applicant/Permitee: Signature sued B : Signature
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I Building Permit#: ZJ ✓I
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S&W Permit#:
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Permit Fee: /► 'q
�1 Date Received: f7'1 . ICJ
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3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 I I
(651)675-5675 1 FAX:(651)675-5694 I Date Issued:
buildinainsoectionsOcitvofeagan.com t_____________________J
RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 1273 CA9 L.59 N LAK& 4/t� Unit#:
Applicant is: ❑ Owner d Contractor
Name:-- kj?A lBC—_
Homeowner Address:12?3 UlJel_,- tQ � L42e'!5� Ljft.1 City:
State: Zip: Phone: Q EYnail:
Description of work: 96g2vEtv
Type of
Work Construction Cost: at)Oe, v�
Type of building: ASingleFamily ❑ Townhome, of units ❑ Twin Home
Company: I'A /'/ , C Contact: L o NGl
Building Address: Gt e City:
Contractor
StateZip: Phone Email: V1401'�JT ,rte
License#: Ex iration Date: �—
Sewer& Company:p y Contact:
Water
Contractor Address: City:
Required for State: Zip: Phone: Email:
new construction
License#: Expiration Date:
❑ 1 understand that Plumbing, Mechanical, and Fire Suppression work require separate applications.
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. Contact Gopher State One Call at(651)454-0002 or www.000herstateonecall.ora for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground k4flities.
I hereby acknowledge that this information is complete and accurate;that the work will be in con ance wi h he 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 i not to start w'hout permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of ans.
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Applicant's Printed Name Applicanta4kj6atuee