EA188341 - Building - Single Fam - Issued Date 12/07/2023City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675-5675
www.cityofeagan.com
Site Address: 4040
Lot: 18 Block: 10
PID: 10-16704-10-180
Use:
PERMIT
Permit Type: Building
Permit Number: EA188341
EAGAN
* E R 1 8 8 3 4 1
Amethyst Lane
Addition: Cedar Grove 5th
Description:
Sub Type: Single Fam
Work Type: Alteration
Description: Bathroom Remodel
Census Code: 434 - Residential Additions, Alterations
Zoning: R-1
Square Feet: 0
Date Issued: 12/7/2023
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0 G B G
Construction Type: V -B
Occupancy: IRC -1
ComlTlents: 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 $83.50 0801.4085
Valuation: 2,000.00 BL - Plan Review 65% $54.28 0720.4222
Surcharge - Based on Valuation $1.00 9001.2195
Total: $138.78
Contractor: - Applicant - Owner:
Mad City Windows & Baths David & Brenda Efteland
5020 Voges Road 4040 Amethyst Ln
Madison WI 53718 Saint Paul MN 55122--290
(651) 500-0514
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
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For Office Use
188341
I Building Permit #:
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�0 I S&W Permit
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EAGAN14 3 O I
� Permit Fee: �
Date Received: I
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 I
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(651) 675-56751 FAX: (651) 675-5694 I Date Issued:
buildinginspectionspcityofeagan.com I---------------------�
RESIDENTIAL BUILDING PERMIT APPLICATION _
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Date: 12/5/23 site Address: 4040 AMETHYST LNUnit #: �mm
Applicant is: ❑ Owner 14 Contractor
Name: DAVID & BRENDA EFTELAND
Homeowner Address: SAME AS SITE ADDRESS City:
State: Zip:9524579632 Phone. Email:
8
Description of work. REPLACING TUB. EXPOSING PART OF EXTERIOR WALL WILL REINSULATE TO CODE
Te of
Work Construction Cost: 4,255 R-1, Cedar Grove
Type of building: 0 Single Family ❑ Townhome, of units ❑ Twin Home
Company MAD CITY WINDOWS & BATHS Contact:
Building Address:
2621 FAIRVIEW AVE City: ROSEVILLE
r Contractor State: Zip: Phone: Email: MN 55113 651-867-438E PERMITS@MADCITYWINDOWS.COM
BC775012 3/31/23
License #: Expiration Date:
Sewer & Company: Contact:
Water
Contractor Address: City:
Required for State: Zip: Phone: Email:
new construction
License #: Ex iration Date:
❑ I 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
nformation may be classified as non-public if you provide specific reasons that would permit the City to conclude that theyre trade secrets.
CALL BEFORE YOU DIG. Contact Gopher State One Call at (651) 454-0002 or www.gopherstateonecall.org 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 requires a review and approval of plans.
xGUADALUPE VEGA x
Applicant's Printed Name Applicant's Signature