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4255 Carlson Lake Lane NcirY of EAGAN WATER SERVICE PERMIT 3795 PBbt Knob Road PERMIT NO.: E gon, MN 55122 DATE: Zoning: _ No. of Units: Owner: Address: Site Address: Plumber: Meter No.: Connection Charge: Size: Account Deposit: Reader No.: Permit Fee: I ogroe to eanplp with fhe Cffy of Eagan Surcharge: Ordinonces. Misc. Charges: r Totol: BY Dote Poid: Dote of Insp.: Inso.: _ crrr *-fAGAN 3795 Pilot Knob Road Eogon, MN 55122 Zoning: _ Owner: Address: Site Address: _ Plumber: _- SEWER SERVICE PERMIT PERMIT NO.: DATE: No. of Units: rd1'1 801) i.a1SL' T T`. 7.,24 eA t--- - T,. ??. PL%ter CY,. I agree to complr with !6e City of Eogon Ordinonces. BY - Date of Insp. 00 , - ? Connection Chorge: _ ' '_'? •"? Account Deposit: Permit Fee: Surcharge: Misc. Charges: Total: Dote Paid: CITY OF EAGAN ? 3795 Pilot Knob Road Eagan, Minn@:ota 55122 P6one: 454-8100 PERMIT Date: ;.tl.y 20, 1977 Site Address: `-'-55 No. Carlson La]ce Isane Receipt No.: Single Residential No ci44 . - Lot ? Block ` Sub/Sec. rh Multi Res., Comm./Ind. ? Nume ciev? New/Alter. / Repair ? 0 3 Address Cost of Instailation O City ^'t. Pau phane; Permit Fee 24.0 ame A. BindeZ' & Son Surcharge '50 Y P Address e 0 St?. 3f3. City Phone: Total This Permit is issued on the express condition that all work sholl be done in occordance with all applicable Stote of Minnesoto Statutes and City of Eagan Ordinonces. Building Officiul ? . ? CITY OF EAGAN ? ' ,? • ? 3795 Pila+ Knob Road Eagan, Minnesota 55122 Phone: 454-8100 PERMIT No. _ Date: Receipt No.: ? Single I ? `?` • Site Address: Residential ` Lot Blotk -? Sub/Sec. -? " Multi Res., Comm./Ind. I Name New/Alter./Repair . 0 ; dress Cost of Instaliation O City - -'aitI Phone: Permit Fee "? - ? Name ' • ' ^ ??. ?'e.'-.er - Surcharge 8 v ? Address ? 4 t ' `e 0 V City `-'? • i' -.?'• . } Phone: Total - This Permit is issued on the express condition that all work shull be done in accordance with all applitable State of Minnesota Statutes and City of Eugan Qrdinances. Building CITY OF EAGAN - 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHON E: 454-8100 BUILDING PERMIT Receipt# To be used for Est. Value Date ,19. 5 Lot Block ' Sec/Sub Parcel No. :i c Name W 3 Address ° ? City Phone ¢ .o Name ? ? Add ? ress City Phone U¢ ?y W Name =0 Address ? W City Phone On Site Sewage _ MWCC System _ On Site Well _ City Water _ Occupancy Zoning Type of Const (Actueq (Allowable) * of Stories Length Depth S.F. Total Footprint S.F. APPROVALS FEES Assessments Permit ? - -?_ Water/Sewer _ Surcharye Police _ Plan Review Fire _ SAC, City Engr. _ SAC, MWCC Planner _ Water Conn. Council _ Water Meter I hereby acknowledge that I have read this application and state gidg. Off. _ Road Unit that the information is correct and agree to comply with all applicable APC _ Treatment P1 State of Minnesota Statutes and City of Eagan Ordinances. Variance _ Parks Copies Signature of Permittee ' TOTAL A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinancea Building Official Permft Ho. Psrmlt Noldsr Oate Telaphone it Plumbing H.V.A.C. Electric Softener . Inspection Dete Insp. Commenb Footings I Footings II Foundation Framing ? Roofing Rough Plbg. Rough Htg. Isul. Fireplace Final Htg. Final Plbg. Bldg. Flnal Cert Occ. Temp. LP Deck Ftg. ` Deck Frmg. , c 40 44 Well Pr. Disp. CITY OF EAGAN ' 3795 Pilof Knob Road Eogan, MN 55122 N2 4410 ' PHONE: 454-8100 BUILDING PERMIT ReceiPt # To be used for pote 19 Site Address - - Erect ?:- Occuponcy ' lot - Biock Sec/Sub. Alter ? Zoning Pnrcel # Repnir p Fire Zone _ E la e of Const T n rge ? . yp Name Move ? ?' Stories W Z O Address _ Demolish ? Front ft, r;+„ pti„„o Grade ? DePth ft. ? Nome 1L7C. -,rr•••,•••s Zo SI1E'll:in? f4V[.. ?? Address a Assessment " { 8 + ~ City Phone Woter & Sew, ? w Pol ice u ? Name FW Fire ?L9 Address Eng. aW Cit Phone Planner Council I hereby acknawledge thot I have read this application ond state that Bldg. Off. the information is correct and agree to comply with ali upplicable Stote of Minnesota Statates and City of Eagan Ordinances. ?PC 5ignature of Permittee - A Building Permit is issued ro: all work shall be done in acco Building Officiol Permit Surchorge '• ? ? Plan check SAC ? Water Conn. ' ?' •)'.% Woter Meter <•?? • C1(? Totol AAt - 50 i, - Itjc • on the express condition that Stote of Minnescta Statutes and City of Eacan Ordinances. ? Pamk # Data lauad PeesMtN Plumbing 7 ??7?'_?/. 1.??' ? • Mechanicol ?•?dd 7'??0 /?+ -7 e!2 - INSPECTlONS DATE INSP. Rough-In Finol Footings Date Insp. Date irop. Foundation Plumbing ? /.!5 Frame / ins. Mechaniwl r r7 v? Final Remorks: , --?, Reoeipt / 1. Date MECHANICAL PERMIT CITY OF EAGAN Fill in numbered spaces Type or Print legibly 3. Job Address 4. Owner 7 / No. Fee S/C ? . ? - 5. Contractor ? Phone 6. Address 7. City State 8. Building Type: Residential Commercial ? 9. Work Description: New ? Add, L? Alter ? 10. Describe 11. Institutional ? Repair ? Type ' No. i ' Equipment BTU - M. Ea. ` Forced Air No. Equiament CFM i Mfg. A r Nandling: Boilers Mfg. Mech. Exhaust Unit Heater Mfg. r Oth Air Cond. e Mfg. Gas, Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with alf ordinances and codes governing this type of work. Signed : for Rough Fi I ? - Inspections: Date Insp. Date1 Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 464-8700 CITY OF EAGAN Remarks Additio Wilderness Run 5th Addition Lat 24 eik 1 Parcel 10 84354 240 01 owner ! "(,?Is?F .r,?aCr /c-street 4255 No. Carlson Lake Ln• State Eagan, NIN 55123 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF, STREET RESTOR. GRADING SAN SEW TRUNK ad\ 1973 132.60 6.63 20 • -- SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA -441/ 1977 160.00 10-66 15 13$.6$ A005104 11-3-77 STORM SEW TRK 1981 247.57 16.50 15 '7 3e -,29 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. 5l? sac y , m PARK '?s est?Ybi2 TS months from #o 7 -V ZR Z?_ Date of this Request $-I9!!!77 P 22814 I, as UR[.icensed Electrical Contractor 0 Owner, do here6y request inspection of the above electri- . cal winng ms ed at: ?j ? ?14!? Street Address or Route No. 4255 N, aarl son La:ce C;tyEa?an Section Township Range County DA$Ots which is occupied by Til e en Hone e (Name of Occupant) Is a roughin inspection required on this job? No ? Yes EX Ready Now ? Will Call MR PowerSupplier D8kota Gty_ _ Address P'armirgtnn Electrical Contractor 0• B. Thompaon Ell:etPie Contractor's Licenae No.a.2?.@. (Company Nama) Mailing Address 12201 Mtka $lvd M a (Elec 1 ntractar? Ow er akingTnis installation) Authorized Signature L.GYa??Phone No. 9I3-7591 (Electrical Contr r or Owna, Making TMS Installation) BOiIYRD 411OPY Minnesota State Board of Electricity 1964'Upiversity Ave., St. Paul, Minn. 55104-Phone 645-7703 ' REQUEST FOR ELECTRICAL INSPECTION EHECK BELOW WORK COVERED BY TH1S REQUEST * o7-?z a'?:z- p 22814 Type of Building 'New Add. Rep. Check Appliances W ired Fot Check Equipmrnt Wired For Home 7M ? ? Range Temporazy W'uing ? Duplex ' ? ? ? Water Heatex ? Lighting Fixtwes n Apt. Bldg. ? ? ? Dryei ? ?¢ Electric Heating ? Commercial Bldg. ? ? ? Furnxce ?p?i yp Silo Unloeder ? lndustrial Bldg. ? ? ? Au Conditloner ? Bulk Milk Tank 0 Dl! i h . Diah XS L?h Other ? ? ? ers? ? ere 'S! p ers Here ? COMPUTE INSPECTION FEE BELOW Secvice Entrance Size: # Fce 1 1 FeedeasBSubteeders: # Fce Cucuifa: # Fee 0 to 100 Am s. i 0 to 30 Am res l 0 to 30 Am eres 101 to 200 Am s. tr 31 to 100 Am eies 31 to 100 Am ies Above 200_,Amps. 1 1 Above 100 Amps. _X Above lO?Am s. Transformecs RemoteControl Paztialor otherfee ' s 1 1 Special In cti " Minimum fee $5.00 Remazks Aa)V I, the Electrical Inspector, hereby certify?he a??pvQ'ms?pection has bee made. ?-00 (Rough-in)//?4 / f Date ^ :7 (Final) Z/'- , /TA-,. .. Date;2 This request void 18 months from ' CITY OF EAGAN nJ° 13 7 4 0 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 BUILDING PERMIT PHONE:454-8100 Receipt # --i 44 :;e-6 To 6e used for PORCH Est. Value $2.000 Date JliNE 8 ?g 87 Site Address 4255 NO CARLSON LK LN Lot 24 Block Parcel No. Sec/Sub. WILDERNESS RUN 5 OnSiteSewa9e MWCC System On Site Well City Water c Name MICHAEL NOBLE z Address 5AME ? City Phone 452-6576 o Name ? a Address P City Phone wW Name_ w s? Address aw City_ I hereby acknowled9e that I have read this appficatlon and state that the inform8tion Is correct and agree to comply with all applicaqla State ot Minnesota Sta?tutes and City o gan Ordina ces. Signatwe of Permittee?Z MICHAEL N BLE 1 APPROVALS Assessments WateUSewer Police Fire Engr. Planner Council Bldg. Off. APC Variance OFFICE USE ONLY _ Occupancy _ Zoning _ Type of Const _ (ACtuaq (Allowable) ak o( Stories Length Depth S.F. Total Footprint S.F. FEES _ Parmi[ _ Surcharge _ Plan Review _ SAG City _ SAC, MWCC _ WaterConn. _ WalerMeter Road Unit Treatment P7 Parks Copies TOTAL $37.50 1.00 A Building Permit is issued to: on the express condition that all work shall be done in accordance with a plble State of inne?ota Statutes and City of Eagan Ordinances Building Offfcia! t vo ? 1987 B[TILDING PERMIT 9PPLICATIOH - CI1R OF EAGAN SINGLE FAMILY DWELLINGS INCLIIDS 2 SETS OF PLANS, 3 CERTIFIC9TBS OF SORVEY, 1 SET OF ENERGY C9LCOLATIONS $OTE: ADDRESSES FOE CORNER LOTS - C06TRACTOR/HOMEOWNEH HIIST DESIGHATB AHICH 6DDRESS IS DFSIRED. NO CH9NGES FTILL EtS ALLOWED ONCE BDILDING PERMIT IS ISSQSD. MpLTIPLE DiiELLINGS - RFSIDENTIAL RSNTAt, DPITS FOR S9LE QNITS INCLUDE 2 SETS OF PLANS, CEETIFICATE OF SOHVEY - CHECg WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMFIERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, > o $2,000 LANDSCAPE BOND To Be Used For:?.??? ?bf" Valuation: Date: Li Site Address Lot -?? Block On Site Sewage_ s? ,-?,?` \ MWCC System Pareel/Sub 1,J,L(?j(?,A?? ?J?iQ? On Site Well City Water _ Owner M t(?AAS L..-j M 1C.??'tll:i. IJ ai3lii Address 4D??J fvp, C.?.?I,Sw C-y. LN. City/Zip Code (?°?L-sl?N M'`? • ??:?.? Phone yAPPROV9I.S J Contractor 5AL1- Address City/Zip Code Phone Arch./Engr. _ Address City/Zip Code Phone It Assessments Water/Sewer Police Fire Engr Planner Council Bldg Off APC Variance Occupaney Zoning Type of Const (Actual) (Allowable) # of Stories Length Depth S.F. Total Footprint S.F. FE&S Permit 3T 50 Surcharge Plan Review SAC, City SAC, MWCC Water Conn Water Meter Road Unit Treatment P1 Parks Copies TOT9L ? cirr oF eacaN 3795 Pilot Knob Road Eagun, MN 55122 N? 44 ? ? • PHONE: 444-5700 BUILDING PERMIT APPLICATION $36,000. Receipt # To be usad for Sing, Feut Dwlg, d Gaig, pateJtllv 19, 79-1-L Site Address o• 8r gOn 8 e n Erect C]X Occupancy- T Lot 24 Block 1 Sec/Sub. WR Sth Alter ? Zoning Rl Porcel # Repair ? Fire Zone _ Enlarge ? Type of Const. V w Name TimothY Cusick Move ? # Stories 3 Address Demolish ? Front 69 - ft. ° Ci Phone Grode ? Depth 26 ft. p Nome Tilsen HOIDes, LAC. ApDrorals Fees Z? 627 SO. Snelling Ave. Assessment-- - Permit LAR 00 - 0? AddreN . au 454-4784 Water & Sew. Surchorge 18_ 50 Phone Police Plon check w Name 119 Fire SAC F ?Z Address Eng. Water Conn. 234.00 aW Ci Phone Planner WaterMeter6.Q..00 Council _ 1 hereby acknowledge that I have read this opplication ond state ihot gldg. Off. the infortnation is correct and agree to comply with oll opplicoble State of Minnewta Statutes and City o4 Eagan Ordinonces. APC Total 991.5f) Signoture of Permittee - A Building Permit is issued to: all work shall be done in,6cco on ihe express condition that Minnesota Statutes and City of Eogon Ordirwnces. Building Of4ltiol Date : 1- ? - `i 7 BUIL1)I[?G PERitiiIT P.PPLxCF1TT09t LOT Bi,OCN. ? AJDIiI0:7 0 PA2iCEL & SECTIOiJ 1dUi1BJER IF Ui1PL:iTTEll .AJI7RESS OF PARCEL 'L013I:1G h" ( OCC[IPARiCY _T USE 'S/"L-.{? ESTZ+SA'iLD COS_ x °R(O / O" / OPT!]E2_____C? TEf.EPfI0I1E IVO. ADDRESS COtaTRRC?OR ? TELEpzIorTE ;TO. y7F"?? Ydote: Include site p2an; buildiag plans, and anercry calculations with this application Signed OPFICE USE vau.unTZgi; 36 6 0 0,f Sr1C i<x'1aET_2 CO?a;7EC_7I01.+ TJATE& '.:9ETER sarr,nrnJC PERisIT FEE SURCHARGE FLR P7,}ifl C'r:I:CK FI':; PARIC DEDIC:,TIOlU PEE OT: cR TOTF:L* 11P5.no1 ,'i G,n- nn /O S' o?o , M SQ b` APPROVP.LS: ? aSSESSi4E_IT C:.?ERK ?. I? AUFLDIAIG DEPT. POLICE DEPT. ? *7ATER & 5Z'sT7ER 9EPT. FSIL-?h:PT. PAItiC DEPT. . , ? ? ? ? F-I M ? . ? ? ? t,J ?S ?? ---% .?rr ? ( Q i ,.. ? S ti i / I E:? t ? ?..eooE.e rv LlNE- ( i I ?-- .?.y ?----? , Lor ? BLo? k ? , b - ? i -PLOT ?L kcq , ,. ... _, l al{-?i ,• ?" QTBRYOR SIVE(M SZACB 'Q" CWM4lM. (To be Sn6attted vith tullAiag paroit applicatlaa) ? er itro faiilY dwelling A11 ether owaer sit* Addnsa ??'? .S?/??, C G? L.? CoMtraetor Date Phone LIIIEAL P?. OF CCPOSED WALL + :?_fte above g„de- , r TOTAL SXPOSED WALL ARNA SQ. FT,^ _ T'• 7PAQtTE IiALL COIiSTRUCTION: "T" value R area _ sq, ,U,f , . iull nfereoee ' f_ , , x •q* fram v?? z aq• uehod sheste x ¦9• . ??_ s4• u?n s4' z sq. noa+s: tvl@ vaLue x Afts ft. . (ID) ft. ft. . ? ft. . ? ft. •"",.4_ r, ft. . . ? ft. . ? (U' (A)? (A), (A) W? (e) f i - - - --1, , . . ? - _ ..... ...??.? ._. _ _ d`'.1.?. . _ _ . . .:: ?q.ft, ? 6 tppa „ .. ? ?q.ft, ' ft. ft. •_ "* r? aq.ft, ? ?q,ft. - nUn „• ' , - I sq• -. 1?. • 6:. 1/ a w .? sQ t?n' . i" a ^ a Z /q.. ? ?t• ' e .-.?, r1,fn . ?` x.q V 0U6t. "G" value I •rea k. a cyp• 1 ? ., „??? o , _ .q. . vpp _ +9• ? . ' i JJ = ?'?? t ?r'?? I q• ML (U) (Aj. VALIJES ?-y . ?,•? ? ?tr_= 7 4 C. J F s9' 'ID=D DT TOTAL RALL ARPA ??.i . AVG. ZA" "U". .17 or less for 1 b 2 fasily dvelling• .22 or leas for all other buildings FAEI1..I11G: At, ARPA: all rifsr-nea aq; ft, le+0? ?v??? ..?Z z sq. be6Ml shooa x a9. B!'Lb* op?pip?? x " a9. ?M! U" z ? 9• x eq, kL (YJ) (,?) vwUES 4- DID 1! 10TAL ROOF/ . ,IIFG ARM ` '*?.?1 ? ? r' ? ct. .?. c , 2_? - 24 , ro) (si ft, . _ ? ) (A)' ft.?.-.?(U) w ft.- wj ? ft._ +`? ; ` = - 2(tj) I ft. ft. ft. d.•-J.w' ToTAi.S &. •q. fc.--?:.a , o+v? ft._ l''7C?' . 11.?,? ? ft. . ? ft,. w, . ft. ? ' w f ec, . M (y ',_; a?,?.b'.-r?.:TALS ' 6^ -, aq. ft. 4_ S, 4 NI GU;.. I _ _ _ -' ??+?+ata+`+e.'m e•aa. : ?.?. ....., ' , ? ? OS'ter watlalmM rMis .1.0 !x a11 et6os aatruntiar ?0?/?[II.n16e R- vtlw 2. 3, 4. 5. 6. A- r_?n_.. DMsWcrwu rR?xM: • '? ._• 2 1. 2. 3. 4, s. 6. .?. ? --- •-, :-. ?. . i ? . ? , _. If annge •v" vatnes an r.aienlatea aDOw ao uot mut the iiwsp CoAe nquirmasta, tM "Alteenat• Emnlope Deslgn" as oatliud La Sffi 6006 (s) my 6e wed. Additiarl ahoats my be nsod to shar ealaulatimm. ?'. .. ' • RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN ts-J 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 New Conetructlon • 3 registeretl sBe survays showing sq. fl, of lot sq. lt. ol house; anG gp (oofed areas • 2 copies of plan (20% maximum lot coverage albwpd) . 1 Set W Energy Cakulatbns for heated addttions • 2 copies of plan shaving beam 8 wintlow sizes; pouretl fauntl dasgn, etc.) • 1 stte survey for exierior addlNons & decks • 1 set of Energy CalculalWns . Indicete if home serretl 6y septic s}stem for addllions • 3 copias of Tree Pr65ervatbn Plen A lat plettetl a%er 7/1/93 • Rim Joet Detail Optqns saledbn sheet (bMgs wMh 3 or lass units) DATE 6-10 ` 10 o t VALUATION 2 Sc 0 0 SAF I SITE ADDRESS 425-5- C'?} R( S a?J Z LC L4a K P3 MULTI-FAMILY BLDG _ Y ? N TYPE OF WORK ?x ; wa CLe),,+ FIREPLACE(S) _ 0_ 1_ 2 APPUCANT STREET ADDRESS '&A 6 d^J STATE /ar-J LP >; 1Z-3 TELEPHONE # GLI ??f5z o?Kt CELL PHONE #?'la?6j6- (7o j FAX # ? PROPERTY OWNER S?e -o H N G c?c/ f/,/ iELEPHONE #??? ?Z- _______'_'__________________________'__'_------------°.._____-__---___'____-_-__'-'__'__'___"- COMPLETE THIS SECTION FOR uNEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RULES 7672 (J submission type) • Reaidential Ventilation Category t Worksheet Submittetl • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor: Plumbing system includes: Mechanlcaf ConfraCtor. Mechanical system includes: Sewer/Water ConhaCtor. _ Water Softener _ Water Heater _ No. of Baths _ Air Conditioning Heat Recovmr.& Phone # Lawn Sprinkler No. of R.I. Baths Phone # Fee: $90.00 Fee: $70.00 002? 4)ne # -------------------------------------------------------- ?-----°°----------- - - - - - - - - - - - I hereby acknowledge that I have read thls applicati state that°-_ ion is correct, and agree to comply with all applicable State of Minnesota Statutes and C Y agan Ord'rnances. Signafure ofApplicanf G/1 ? OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4I02 14 ? ?r.?y>? , ;' ? t T ? J? JF??,y.' i ? , •'?'? F "N_ti '? ?!' ?ii y? .r..-. ?? . . ?! . { ?• ? . :. ? r ?_ ? .L ? ? . 'f?` ?. - ,? ?,. 4 ? R.'Al . . ' ? . . . ? -? .. . ??e ?•??? M " ????': r : ?. ?.? ? x A vai i??.?? ?`.tr'r ON, , ?? O,t ?f?q3fi l" raVeW*ftti,'ehean+ ? jtt?!*Yj jirip;?t#???qroodmtt M+d rn bomd an • vlawX ';?! d'?r?*?^-?r.. sr? ?o?:,sr. ????as, ?h? nroa?'??,?_?aN??Y? r?ds.' ?"lo t++wifs is tor Lahl"t ,. . 'sa tas*4:: ,T wwvsy. :4 do*s nat corvm"?la 4iidljitjt -,6f t!e Qosllanr !M is WtPAdrf . ? .. . , a ? ? . . ? ? .. .. . . , . ? ? ? r?.^i? Use BLUE or BLACK Ink I For Office Use I City j Permit I of EaEdD I as I Permit Fee: 1 3930 Pilot Knob Road j Eagan MN 55122 I Date Received: I Phone: (651) 675-5675 I - _ - Fax: (651) 675-5694 ; Staff: - - - - - - - 2013 RESIDENTIAL BUILDING PERMIT APPLICATION q j S'T [*Lgr 1 -1 nit Date- Site Address: Phone: Name: NNW 4 Address /City /Zip: _...L 21 ,•I 11 ~ a1111.4 1111`II'ro!k!.".Tix;:ik:bi~yl~]~ll~[}i19i~d& Applicant is: Owner Contractor ;c,qd+ i : Idaq!al 'ir>Ia; ~ tj Description of work: r41'i1;I;~iilifnl:Multi-Family Building, /No~ ~!'+i'';?o;?ff"; ; Construct Ion Cost: Family _ p. ,,~,s ,,~.id~.tdu i E r6 ~,;1►,~lilrir° u, l~ COntaCt: Company: i ;111 d!~;i~lal:if{f~',I~j's; ity: gAddress: ulr~r,M,r~'rGi I sits~li~d State: Zip: Phone: ' Q tiikP.......... B~ yy ' r' " • License 4 Ila Lead Certificate w_2jT0&w 1♦lili5i''i!l i1h11'Illitr rii ~l 1 'r ltPrr!.lil;! If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 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 master plan? Yes -No If yes, date and address of master plan: Licensed Plumber: Phone; Mechanical Contractor: Phone: Sewer S Water Contractor: Phone: I.i'Ilk "•11E Y'1__ ~ - ,..._~'?w!iF- ~ -v ;I Y•!!:!:5!:Tf};r1~i.. " u-,(l'i.'w:. '1:, - r:.~.r•• , dR( ,,p.~, ,..d~, r. t....,.~..d .ar~4Tm.::...". t l•Y••i ,lr ',.a LY -01 9!.;119iG.~ r~ - - c ••m,~.. 4i; G;, ,.I;ttApt•~, Its +r/'''rj~:~L.' I~-F ..~1: ~ay:.•~ Q.~;i, •~Ir.Y.r. ;~,-pyg~. ~IIP ':"11~ R1'iRdli ,a•.•,r''~.C)! t; •,di . ...............:•::.,:o• m.".p ~.-,..,r;;-r:''"~+'.,r•.•.+f 1r. . y t~ ..,err; :::rp, -R 2E:-:, •~'r="C';2__rr r':::._. L I ea r....,,.~~...G''''~! .C........Iy,q,.G":e.rl,tpc'•tYl,di~,l;.;: yy1 yy, •I't qq~"SS'' e.k!IiA3 r:rt;.e!ry!ItGi:P~''•rlil.°.o':':dii.Gl,r','1~•tluY:..,lflrElf• 11eru.r,J.oM171717~rliri_c,l;iiima., .w.., um:.,ft"". r,,,...k.,,+_. d _ '>,Iv^}r- q.i..l_• e:rJt dl''~ uii~'i~►r~l ~ ..7i!• kil. CALL BEFORE YOU DIG. Call Gopher State Ono 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. wym-gopherstgteonecali.org 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 '$'p t a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accorda/Widththe ed in the case of work which requires a review and approval of plans. Exterior a building permit issued In accordance with the Minnesota State Building Code must be completed within 180 days of x x App cant's P to Name Applicant's Signature Page 1 of 3 b0/T0 3JCd d3SI>i BT909T££9/- ££:60 £TOZ/ZZ/0T