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1377 Amaryllis Lane
EAGAN TOWNSHIP BUILDING N? 2922 --?c, Owner ._.? ........... ...... ......... ..?.... ....._._._.... Eagan T ?? Address (present) e . _--. ._ ...... Town Hall Builder ---. -------------------------- .------------- --• -.. Date 1 ........................... '`IF- ....... Address ................. .. .......................................................... DESCRIPTION Stories To Be Used For Front Depth Height Est. Cost ermil reel Remarks 17 1 A/ 7/- LOCATION s (. Street. Road or other Description of Location Lot Block Addition or Tract /367#-/377 , /376> 13 9?? J39a •? I.9/3,? This permit does not authorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent . the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE 19EPT ON THE PREMISE WHILE THE WORK IS IN PROGRESrS. This is to certify, that--- .... ... .......has permission to erect a-...2.. ......::'.... _.... . „....._ttpon the above described premise subject to the provisions of the Building Ordinance for Eagan T April U. 1955. . t w Per „' --... ?? ,?. ..__.. at 1w" Board I ? smveetev y C B u i l d i n g Y MASTER CARD LOCATION f • OWNER STRUCTURE AND LAND USED AS Permit No. Issued Issued To Contractor Owner BUILDING PLUMBING CESSPOOL - SEPTIC TANK WELL ELECTRICAL HEATING GAS INSTALLING '? -=? . SANITARY SEWER OTHER OTHER Approved Items (Initial) Date Remarks FOOTING FOUNDATION q FRAMING FINAL ELECTRICAL HEATING GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING e 'L WELL -t--? SANITARY SEWER 4 W COMMENTS: Distance From Well SEPTIC CESSPOOL TILE FIELD FT. DEPTH OF WELL Violations Noted on Back COMPLIANCE INSPECTION REPORTS TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS PERMIT NO. DATE OF INSPECTION CONDITIONS OF CONSTRUCTION AT THIS INSPECTION ? NO EVIDENCE OF NON-COMPLIANCE NON-COMPLIANCE. BUILDER DOES NOT OBSERVED. L,, J INTEND TO COMPLY. a ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. Q COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED BY CONDITIONS BEYOND ? NON-COMPLIANCE. BUILDER WILL COMPLY CONTROL. WITHOUT DELAY. ITEMIZED AND DESCRIBED AS FOLLOWS: ? REINSPECTION REQUIRED REINSPECTION REVEALED DATE OF REINSPECTION CERTIFICATION -I certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require- ments for off-site improvements relating to the property inspected, F1 ALL IMPROVEMENTS ACCEPTABLY COMPLETED BUILDING INSPECTOR DATE COMMENTS: sa -11L U- SE OF EAGAN 3795 Pilot Knob Rood Eagan, MN 55122 Zoning: R-1 Owner: Address: Site Address: --1-3TJ WATER SERVICE PERMIT PERMIT NO.. 1545 DATE 7/10 74 No. of Units: 1 Plumber: Peters Bey-Roc Meter No. ?? Connection Charge340. 00 pd Size Reader No.: I agree to comply with the Village of Eagan Ordi ces. By Date of Insp.: Account Deposit: Permit Fee: 10.00 pd. 7/18 Surcharge: .50 pd 7/18 Misc. Charges: Total: Date Paid: Insp.. -?G VILLAGE SF EAGAN SEWER SERVICE PERMIT 3795 Pilot Knob Rood PERMIT NO.: 2304 Eagan, MN 55122 DATE: __ 18/74 Zoning: R-1 No. of Units: Owner: Tiisen Onstruction CO. Address: -- Site Address: 1 77 AmarYllis Lane (4-2-4JRG - Plumber: Peters 400.00 pd I agree to comply with the Village of Eagan Connection Charge: Ordinances. Account Deposit: 7 18 10.00 pd Permit Fee: .50 pd 7/18 Surcharge: By: Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: CITY OF EAGAN Remarks Addition Lot 4 / Blk 2 Parcel 10 84351 ` 02 Owner trees 1377 Amax lI i.s L AA 9- State Pagan. MN 55 12 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK 1973 $175.00 8 .75 20 PAID SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK 1 /JJ 1981 C005447 6/9/80 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. $280.00 10 /roz - - BUILDING PER. SAC $400.00 10762 6-4-74 PARK CIT. OF EAG I' 3795Pilot Knob Road Eagan, Minnesota 55122 PERMIT NO. The City of Eagan hereby grants to ft U, •b+ d yeti of 99 No. U a Permit for: (Owner) TUM cmatmxwm 377 rrIlia Lane, 1447 Balsam St., 1354 Cosmos Lane and dan Trail , pursuant to application dated 9 Fee Paid: $$ s00 dated this 18th day of Sept. , 19, 74 2.00 a/c Building Inspector Mechanical Permits: Bid Total: 1377 /0 w3S/ IOoz CITY OF EA AN 3795 Pilot Knob Road Eagan, Minnesota 55122 PERMIT NO. 505 The City of Eagan hereby grants to L. T'. ^eter Co. of rt . T'au] x+5105 a nrsTUrra:T?r_ ! Permit for: (Owner) Tilsen Construction Co. 1377 Amaryllis Lane and at 350 GavAen Trail , pursuant to application dated 9/11/74 Fee Paid: _______$4n_no dated this 13th day of Sept. 1974 . 1.00 s/c Building Inspector I' cra:.ical Permits Bid Total: CITY of EAGAN `Q 4 114 BUILDING PERMIT $795 Eagan. PiloMt. ?e Knob Road Owner .?s. ....................................... Minnesota *u8122 Address (present) ../..32?.. ?_, 454-8100 Builder . '.' Dab ?tt- Address . •-- DESCRIPTION Stories To Be Used For Front Depth Height Est. Cast Permit F. smaritr boa lg.?? 01 LOCATION Street. Road or other Description of Location Lo! Block Addition or act This permit does not authorise the use of streets, roads, alleys or sidewalks nor dope it give the owner at his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE PT ON E PR MISE WHILE THE WORK IS IN PROGR S This is to certify, that .......... .has permission to erect a-...... ....... ..........?..._.. _upoa the-above described premise subject to the provisions of all applicable Ordinances for the City o Eagan. ? Per ............. Mayor $'ttilding Iraepecto s r?_ • J MASTER CARD LOCATIO /e,'r' I OWNER W STRUCTURE AND LAND USED AS Permit No. Issued Issued To Contractor Owner BUILDING PLUMBING CESSPOOL - SEPTIC TANK WELL ELECTRICAL HEATING GAS INSTALLING SANITARY SEWER OTHER OTHER Approved Items (Initial) Date Remarks FOOTING ++ FOUNDATION FRAMING FINAL ELECTRICAL HEATING GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER COMMENTS: Distance From Well SEPTIC CESSPOOL TILE FIELD FT. DEPTH OF WFII Violations Noted on Back COMPLIANCE INSPECTION REPORTS TO BE UIW ONLY IN WENT OF OBSIMM VIOLATIONS PERMIT NO. DATE OF INSPECTION CONDITIONS OF CONSTRUCTION AT THIS INSPECTION ? NO EVIDENCE OF NON-COMPLIANCE ? NON-COMPLIANCE. BUILDER DOES NOT OBSERVED. INTEND TO COMPLY. ? ACCEPTABLE SUBSTITUTIONS OR COMPLETION OF CERTAIN IMPROVEMENTS DEVIATIONS. WILL BE DELAYED BY CONDITIONS BEYOND CONTROL. LI NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. ITEMIZED AND DESCRIBED AS FOLLOWS: REINSPECTION REQUIRED DATE OF REINSPECTION REINSPECTION REVEALED CERTIFICATION-1 certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require- ments for off-site improvements relating to the property inspected, Q ALL IMPROVEMENTS ACCEPTABLY COMPLETED BUILDING INSPECTOR DATE COMMENTS: 23 RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 1 3 --? 651-681-4675 Now Construction Requirements RemodellRepair Requirements • 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas • 2 copies of plan (20% maximum lot coverage allowed) • 1 set of Energy Calculations for heated additions • 2 copies of plan showing beam & window sizes; poured found design, etc.) • 1 site survey for exterior additions & decks • 1 set of Energy Calculations • Indicate if home served by septic system for additions • 3 copies of Tree Preservation Plan if lot platted after 7/l/93 Rim Joist Detail options selection sheet (bulge with 3 or less units) DATE Moll Q)-o VALUATION I- SITE ADDRESS MULTI-FAMILY BLDG Y ? N TYPE OF WORK FIREPLACE(S) 0 1 2 APPLICANT ? -k 0 A-- STREET ADDRESS 4 I 3 1? t n k1@_I)b (b k CITY IAA'IQOP TATE JZIP. 1.1 TELEPHONE #tc - 1 a%-O (CELL PHONE # FAX # PROPERTY OWNERS h q I c L i TELEPHONE # ?o I -1oK ?BOALI.? -• ------- -------------------------------•-------------------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY I MINNESOTA RULES 7672 ('1 submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor: ..... -----------------------_ Phone # -__ Plumbing system includes: Water Softener Lawn Sprinkler Fee: $90.00 Water Heater No. of R.I. Baths No. of Baths -? Mechanical Contractor: Phone # Mechanical system includes: Air Conditioning Fee: $70.00 Heat Recovery System Sewer/Water Contractor: Phone # I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant MAY 1 fi 2002 ----------OFFICE USE ONLY------._v------------- Certificates of Survey Received Tree Preservation Plan Received _ Not B rued Updated 4/02 OFFICE USE ONLY ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool 13 30 Accessory Bldg O 02 SF Dwelling 0 08 06-plex ? 16 Fireplace 0 21 Porch (3-sea.) 0 31 Ext. Alt - Multi 0 03 01 of _ plex ? 09 07-plex 0 17 Garage 0 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF 0 04 02-plex 0 10 08-plex ? 18 Deck 0 23 Porch (screened) 0 36 Multi 0 05 03-plex ? 11 10-plea O 19 Lower Level © 24 Storm Damage ? 06 04-plex 0 12 12-piex Plbg,„_-Y or N 0 25 Miscellaneous 0 31 New 0 35 Int Improvement 0 38 Demolish (interior) 0 44 Siding 0 32 Addition ? 36 Move Bldg. 0 42 Demolish (Foundation) 1 45 Fire Repair ? 33 Alteration ? 37 Demolish (BIdg)* ? 43 Reroof ? 46 Windows/Doors 0 34 Replacement *©emollition (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MCIES System Census Code Zoning city water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS Footings (new bldg) Final/C.O. Footings (deck) c _. Final/No C.O. Footings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof - Ice & Water Final - Pool Ftgs Air/Gas Tests -Final Framing Siding _ stucco Stone Fireplace _ R.I. Air Test Final Windows (new/replacement) Insulation _ Retaining Wall Approved By - ----- - ----- ---- - , Building Inspector ---------------------- Base Fee ---- - Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total RESIDENTIAL S BUILDING PERMIT APPLICATION CITY OF EACAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 NmConstnicNon Reawrements • 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and aif roofed areas (20% maximum lot coverage allowed) • 2 copies of plan showing beam & window sizes; poured found design, etc.) • 1 set of Energy Calculations • 3 copies of Tree Preservation Plan if lot platted after 7/1/93 • Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE SITE ) TYPE 1a D RemodetfRensir Requirements • 2 copies of plan • 1 set of Energy Calculations for heated additions • 1 site survey for exterior additions & decks • Indicate if home served by septic system for additions STREET ADDRESS PROPERTY OWNER h I TELEPHONE LJ O b COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category MINNESOTA RULES 7670 CATEGORY I MINNESOTA RULES 7672 ('i submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor: Phone # Plumbing system includes: - Water Softener , Lawn Sprinkler Fee: $90.00 Water Heater No. of R.I. Baths No. of Baths Mechanical Contractor. Phone # Mechanical system includes: Air Conditioning Fee: $70.00 Heat Recovery System Sewer/Water Contractor: Phone # I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicar --- - - - - - ------------ - OFFICE USE ONLY Certificates of Survey Received Tree Preservation Plan Received _ Not Required Updated 4/02 VALUATION ° OC) OFFICE USE ONLY ? 01 Foundation ? 07 05-pier ? 13 16-x ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling 0 08 06-plex ? 16 Fir ? 21 Porch (3-sea.) ? 31 Ext. Aft - Multi ? 03 01 of - plea ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt • SF D 04 02-piex ? 10 08-plex © 18 Deck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex D 12 12-plex Plbg__Y or N ? 25 Miscellaneous ? 31 New D 35 Int improvement ? 38 Demolish (interior) ? 44 Siding ? 32 Addition D 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 D (Bldg)" ? 43 Rexoof ? 46 Windows/Doors ? 34 Rep nt *Demol!ition (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning __ _ _ City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Width REWIRED INSPECTIONS Footings (new bldg) .r. Final/C.O. Footings (deck) Final/No C.O. Footings (addition) Plumbing Foundation HVAC Drain Tile Other Roof - I e & Water Final Pool Ftps Air/Gas Tests Final Framing _ Siding _ Stucco _ Stone Fireplace - R.I. `Air Test Final Windows (new/replacement) Insulation Retaining Wall Approved By , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total ° ?-- RESIDENTIAL BUILDING Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Reeameemea R /Repair Requirements 3 registered site surveys showing sq. ft of lot sq. ft of house; and an roofed areas 2 copies of plan (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions 2 copies of plan sho beam & window sus, poured found design, etc. I site survey for additions & decks 1 set of Energy Calculations Addition - indicafe if on-site septic system 3 copies of Tree Preservation Plan if lot platted after 711193 Rim Joist Detail options selection sheet (bldgs with 3 or less units l 7/ 2 Office Use only _ Cert of Survey Read _ Tree Pros Plan Recd _ Tree Pies Not Regd _ On-site Septic System Date 7 / 4-k / O 3 Construction Cost ia., e yyo Site Address / 3 721 T L S ,,p Unit/Ste # Description of Work 1 u 5APzA!e l Multi-Family Bldg Y N Fireplace(s) 0 _ 1 2 Property Owner 1 lit L Telephone # { ) Contractor Z-A L41 4' Y?,, y l j S 11L r- Address ( 5 Gd tQd Lt city, -54 / d_tL I ? State Zip /O Telephone # (657) COMPLETE THIS AREA ONLY IF CONSTRUCTING A N 1' BUS LDING Mi mesota Rules 7670 Category 1 Minnesota Rules 7672 Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (d submission type) Submitted Submitted • Energy Envelope Calculations Submitted Licensed Plumber Telephone #( } Mechanical Contractor Telephone # ( ?)_ ?Ll Sewer/Water Contractor Tetepho I hereby apply for a Residential Building Permit and acknowledge that the in ati accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; 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. 57 ey'e l/cn t5 ' ?? _ Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory 849 ? 02 SF Dwelling ? 08 06-plex Cl 16 Fireplace Cl 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) 0 33 Ext. Alt - SF ? 04 02-plex 0 10 08-plex ? 18 Deck ? 23 Porch ( gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-piex Cl 18 Lower Level ? 24 Storm D ? 06 04-plex ? 12 12-plex Plbg_v or - N ? 25 Miscellaneous Work Types ? 31 New 0 35 Int Improvement ? 38 Demolish (interior) Cl 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof Cl 48 Wkviows/Doors ? 34 Replacement *M (Entire Bldg) - Give PGA har ut to applicant Valuation Occupancy MCIES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Wit IIEQU.IIIED INSPEC:"1`IONS Footings (new bldg) Final/C.O. Footings (deck) F' o C.Q. Footings (addition) - Plumbing Foundation ? HVAC Drain Tile . Other Roof - Ice & Water Final Pool _ Ftgs - Air/Gas Tests - Final Framing _ Siding Stucco _, Stone Fireplace _ RI. - Air Test - Final Windows (new/replacement) Insulation Retaining Wall ?ra.?rr? rrwN?rrr? ??.r+.rwrrY --°_ _ w w r e Approved By Bukft Inspector . Base Fee w ?wie.+ wra a?rww,urr??rr . +rw«swl+w-wr+.rs r Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA108720 Date Issued:01/07/2013 Permit Category:ePermit Site Address: 1377 Amaryllis Lane Lot:004 Block: 002 Addition: Wilderness Run 2nd PID:10-84351-02-040 Use: Description: Sub Type:e - Water Heater Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Kris Oien 3670 Dodd Rd Eagan, mn 55123 651-365-1340 Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087 Surcharge-Fixed $5.00 9001.2195 $60.00 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 - Min Ying Li 1377 Amaryllis Lane Eagan MN 55122 Champion Plumbing 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365-1340 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA116666 Date Issued:10/09/2013 Permit Category:ePermit Site Address: 1377 Amaryllis Lane Lot:004 Block: 002 Addition: Wilderness Run 2nd PID:10-84351-02-040 Use: Description: Sub Type:Reroof & Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to ensure maximum ventilation to attic. Call for final inspection after installation. Fee Summary:BL - Base Fee $8K $162.25 0801.4085 Surcharge - Based on Valuation $8K $4.00 9001.2195 $166.25 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 - Min Ying Li 1377 Amaryllis Lane Eagan MN 55122 (952) 465-6523 Twin City Roofing Construction Specialis 72 Ivy Ave W St Paul MN 55117 (651) 636-9640 Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink --------------, � For Office Use I � I C�iy V! 1J���11 I Permit#: � � , 3830 Pilot Knob Road � Permit Fee:�/�� ' �� � Eagan MN 55122 I � I Phone:(651)675-5675 � Date Received: ' � � Fax:(657)675-5694 � � j � Staff: � _________________J 2015 MECHANICAL PERMIT APPLICATION ❑ Please submit two(2)sets of plans with all commercial applications. Date: r I - 3 ' « Site Address: 1��7 ./"r �'1'1 c.�r �t�� �S ���Q- Tenant: ��� �� Suite#: ;< ���h ������,�,����,. Name: �� n � i Phone: � r Z- S bd-'13C'}6 Address/City/Zip: �3-1 �m Ac ��`S � Name: i`�Q-s � c���'k-«� ����..�� i A�c License#: ��"rt?t��C+�CCEi�'.'. Address: 1.g f.�S y\ 5` S"C - S�:,.�c R City: �=-�1�1" ��Tr� �`S "��� '� `� ��;, State: `��n_Zip: ��e 23 Phone: 6 f Z-�'1 Z.�{-l $�7�' z" f �k$` , � %: '` Contact:���e_ �L Email: �l n.r��. �L_c7���c Q, �� �Mc���- C-0 New �' Replacement Additional Alteration Demolition ��C� ��.�v� x.�`j�pe c�f Work Description of work: 1 G � c c�a C.�,.crtdr O�� �S °�C� � �� �N�'����f moc��a � '�c�mour�tad s.� � ��� #��� r���be�cr�'�y b�r city �ri .� .�,�;_ �„�� �. P#�;���`n'�i+Gt�e IIA��t��l C . ,,� ��� �� .�f��!�i�`��n�n���c�efs.' � RESIDENTIAL COMMERCIAL �Fumace _New Construction _Interior Improvement Air Conditioner Install Piping Processed ��:PEt`t�l#�'�/�@�� — — — , _Air Exchanger Gas Exterior HVAC Unit t � � Heat Pump Under/Above ground Tank �Install/_Remove) � �n — — ��'f� Other � � � RES/DENTIAL FEES $60.00 Minimum Add or alteration to an existing unit, includes State Surcharge $100.00 Residential New, includes State Surcharge =$ TOTAL FEE COMMERCIAL FEES � Contract Value$ 3�0� x.01 $60.00 Permit Fee Minimum �p $70.00 Underground tank installation/removal =$ �*,Q Permit Fee Surcharge=Contract Value x$0.0005 -$ Surcharge a If the project valuation is over$1 million,please call for Surcharge =$ � � TOTAL FEE I hereby acknowledge that this information is compiete and accurate; that the work will be in co ormance th 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 ot to s rt with a it;that the work will be in accordance with th roved plan in the ca of work which requires a review and approval of plans. ��� 1 t` X ^ 1 X `\ Applicant's Printed Name ApplicanYs Signatur �G7�,���i-� F�W�V�7C ' �F• ,�•,.x�".. �fv�.y ,y:;.:'`,".��i" ., ry: t .-1�u���' l�x, �t s,:. . "y �.�a,* . v ak � t ,v �`'� �.��€��-.t�-�`-tisx� �" �; *m'r �����'��`1$�N��' r�'� r,��"'�s.�✓'��� ,: u ���� �� ; ���'����` . . �' "���'.s��"r � �� �,.#'-���`'', Uird�rgrourr�i, « E�� tn T��A�rt T�s� �.{���.Gas Serv�t � �}��,:,.,�,:In�fl�;� � �`r�F° ��rt� ��vcr�it� ;:..:.�, �