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)
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- _ ..... ...??.? ._. _ _ d`'.1.?. . _ _ . . .::
?q.ft,
? 6 tppa
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' ft.
ft.
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-
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t?n'
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„??? o
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. vpp
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' 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
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?
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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..-. ?? . . ?! .
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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:
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Phone: (651) 675-5675 I
- _ -
Fax: (651) 675-5694 ; Staff: - - - - - - -
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date- Site Address:
Phone:
Name: NNW 4
Address /City /Zip: _...L
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1111`II'ro!k!.".Tix;:ik:bi~yl~]~ll~[}i19i~d& Applicant is: Owner Contractor
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Description of work:
r41'i1;I;~iilifnl:Multi-Family Building, /No~
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r' " • License 4 Ila Lead Certificate w_2jT0&w
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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:
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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
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