EA187425 - Building - Single Fam - Issued Date 10/17/2023 PERMIT
City of Eagan , , , 9 Permit Type: Building
3830 Pilot Knob Rd E A Permit Number: EA187425
Eagan, MN 55122
(651)675-5675 1111111111111 IN 111111111111111111111111111111
www.cityofeagan.com * E R 1 8 7 4 Z S *
Date Issued: 10/17/2023
Site Address: 1625 Blackhawk Hills Rd
Lot: 7 Block: 3 Addition: Blackhawk Glen
PID:10-14350-03-070 11111111111111111111 IN 11111111111111111111111111 Uff
Use: * 10 14350 - 03 - 070
Description:
Sub Type: Single Fam Construction Type: V-B
Work Type: Alteration
Description: bathroom remodel
Census Code: 434-Residential Additions,Alterations Occupancy: IRC-1
Zoning: PD
Square Feet: 0
Comments: Improvements to the home may require smoke detectors in all bedrooms.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes(Minnesota State
Building Code).
Fee Summary: BL-Base Fee $116.60 0801.4085
Valuation: 4,000.00 BL-Plan Review 65% $75.79 0720.4222
Surcharge-Based on Valuation $2.00 9001.2195
Total: $194.39
Contractor: - Applicant - Owner:
Window Concepts MN Gary James Tste Dise
291 Eva St 1625 Blackhawk Hills Rd
St Paul MN 55107 Eagan MN 55122
(651)905-0105
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 Issued By: Signature
LM t�I,1„YJ I For Office Use
!- 1 187425
t B s I Building Permit#:
1 S&W Permit#:
EAGA :P", j Permit Fee: I 1
10/12/2023
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3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 j Date Received:
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(651)675-5675 I FAX: (651)675-5694 n I Date Issued:
buildin9 an com
inspections cDcitvofea I_________________
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RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 10/12/2023 Site Address: 1625 Blackhawk Hills Road Unit#:
Applicant is: ❑ Owner 0 Contractor
Name: Gary Dise
Homeowner Address: 1625 Blackhawk Hills Road City: Eagan
State: MN Zip: 55122 Phone: 651-253-4831 Email:
Description of work: REplacing 2 showers, wall surrounds and fixtures
Type of $10497.00
Work Construction Cost: PD, Blackhawk Glen
Type of building: 0 Single Family ❑ Townhome, of units ❑ Twin Home
Company: Window Concepts of Minnesota contact: Steve Mickelson
Building Address: 291 Eva St city: St Paul
Contractor State: Zip: Phone:MN 55107 651-604-827 Email: steve.mickelson@wc-mn.com
License#: BC163493 Expiration Date: 3/31/2025
Sewer$ Company: Contact:
Water
Contractor Address: City:
Required for State: Zip: Phone: Email:
new construction
License#: Expiration Date:
0 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.gopherstateonecall.oro for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
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 requiresa review and approval of plans.
XSteve Mickelson
Applicant's Printed Name Applicant's Si ature