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4572 Ches Mar Dr CITY OF EAGAN WATER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO.: • Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber: Meter No.: Connection Charge: Size: Account Deposit: Reader No.: Permit Fee: I agme to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: Total: BY Date Paid: Date of Insp.: Insp.: CITY of EAGAN SEWER SERVICE PERMIT .3795 Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: r. Address: Site Address: Plumber: I agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: Surcharge: - By Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: CITY OF EAGAN -j 3793 Pilot Knob Read Eagan, MN 55122 N°_ 514 5 PHONE: 454-8100 IUILLING PERMIT Receipt # To be used for `K Est. Value Date 19 Site Address r4 A Erect 0 Occupancy Lot Block Sec/Sub. Lf1F`~; Alter ❑ Zoning Parcel # Repair ❑ Fire Zone Enlarge ❑ Type of Const. m Name 7L7S ' & Move ❑ Stories z Address Demolish ❑ Front ft. city Phone Grade ❑ Depth ft. p Name Approvals Fees ~ Address Assessment Permit ~ city Phone Water & Sew. Surcharge Police Plan check FW Nome c r?T`'.:rl-iY? Fire SAC T~ Address Eng. Water Conn. City Phone Planner Water Meter Council I hereby acknowledge that I have read this application and state that Bldg. Off, the information is correct and agree to comply with all applicable APC Total State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee 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 Ordinances. Building Official Pwmlt #t Doh Issued Pwsittee Plumbing 1396 11 4)-?,? Mechanical 41 6-z-'3- 7 9 } IcS iJ -C) -7 k~ IZ i L, INSPECTIONS DATE INSP. Rough-In Final Footings = > = 7`= Dote Insp. Dote Insp. Foundation _ Plumbing Frome/ins. Mechanical Final r j j Remarks: CITY OF EAGAN r1CV :9--l 2 R 11-TWIMT, 3795 Pilot Knob Road Eagan, Minnesota 55122 Phone: 454-8100 MATM PERMIT No. 14 Date: 6--29-73 ? 4960 Receipt Na.: ~r Single 4572 ' Residential }S Site Address: YzX 3rd I Lot Block Sub/Sec. _ Multi Res., Comm./Ind. Name .orns2 & L[-l3r. New/Alter./Repair. P.O. DIM 327 3 Address _ i Cost of Installation viur, City ~~Phone: Permit Fee . c f Pay , e . il L Y?eatim co. Name Surcharge 37 11-iccym F~. Address z f City Phone: Total This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official CITY OF EAGAN 3795 Pilot Knob Road Eagan, Minnesota 55122 Phone: 454.8100 pUfl .Ur, PERMIT No. Z~cv Date: l_ 9-79 Receipt No.: 4939 Single Site Address: ~~72 (1" !-iar Residential Lot Block Sub/Sec. CheS rX 3rd Multi Res., Comm./Ind. Name C'.xMz h r New/Alter./Repair. Address "0' HOX Cost of Installation City 'Ville 55337 Phone: 454-2815 Permit Fee '21 _C , - F'mjecL Pltxt. C(>> i" Nome Surcharge 9743 Hz rml cat . Address c City _ Phone: Total This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official CITY OF EAGAN Remarks Addition CHES MAR 3RD ADDITION Lot 2 Rik 3 Parcel 10 17102 020 03 Owner~jiw J i,, street 4572 Ches Mar Drive State Eagan, MN 55123 _ L'~fcl'nvl+ Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK 'kal 5.42 20 65.02 A008690 12/-q/79 * SEWER LATERAL 1978 2263.13 150.88 15 181.0,52 A009690 12.15/79 WATERMAIN * WATER LATERAL 1978 WATER AREA 1977 108.30 7.22 15 7"2 A008690 12,15.179 STORM SEW TRK 1980 347.65 23.18 15 324AS A008690 1215179 * STORM SEW LAT 1978 CURB & GUTTER SIDEWALK STREET LIGHT Road Unit 75.00 13770 4-4-79 WATERCONN. 270.00 13770 4-4-79 BUILDING PER. #5145 SAC 525.00 13770 4-4-79 PARK I INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT: PERMIT SUBTYPE: TYPE OF WORK: I I AI1= INSPECTION DATE INSPECTION TYPE DATE INSPTR. J Permit No. Permit Holder Date Telephone # ELECTRIC PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH l PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYPSOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FTG DECK FJW - - Request Date 1 1 Fire No. Rou Inpsecion Required Inspection Other Than Rough-in (You mu Call inapaLler when featly) U Ready Now ❑ Will Notify Inspector ❑ Yea 'fo No DateReatl I [Ki licensed contractor O owner hereby request inspection of above electrical work at: JOD Address (Street. Box or Route No I City 4S a. a. tAGR' i Section No. Township Name or No. Range No. County Occupant (PRINT) Phone No. Power Supplier Address NA> Electrical Contractor (Company Name) Contractor's License No. W2n-16 ,10 Oec- - , eR Mailing Address (Com actor or Owner Making Installation) W, 12), W"z 7S L'S? `JSc Author Ignalure IContr t 'Gi Installation) Phone Number c ~ta3 i11 3I MINNESOTA STATE BOA LELECTRICRY THIS INSPECTION REQUEST WILL NOT Griggs-Midi Bldg. - m StT3 Q~ BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul. MN 55106 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-8800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION ar'°' a~-oy3 ep/ ~~gg 6 ► See instructions for completing this form on back of yellow copy _ ' d pU 5 564 "X" Below Work Covered by This Request New Add, Rep. Type of Building AppliancesWiretl Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Loed Management Comm./Industrial Furnace Other (Specify) Farm Air Conditioner Other (specify) Contractors Remarks: Compute Inspection Fee Below: C rf- # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 _ Amps A 100 Amps Signs Inspector's Use Only: _ TOTAL Irrigation Booms rC{~ Special Inspection Alarm/Communication THIS INSTALLATION MAY B RDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby Rough-h t Date certify that the above inspection has Final been made.? OFFICE USE ONLY This request voi0 16 months from Thi%;,st void 18 months from 3~~• 3 / 25679 Date oofflAr quest_ I, as Q Licensed Electrical Contractor ❑ Owner, do hereby request inspection of the above electri- cal wiring installed at: Street Address or Route No. % dal ( /K t J/s ✓/~/sJ Cit Section Township Range County Which is occupied by p. y/i !✓r= (Name of occupant) Is a roughin inspection required on this job? No ❑ Yes ❑ Ready Now Will Call ❑ Power Supplier Address Electrical Contractor Contractor's License (Compa~f,,rpama) Mailing Address (Electrical ConL[ ctor"or Owner Making This Installation) _ v L G. U Authorized Signature _ A'~.+t-~,f>-1~•C-~, Phone No. (Electrical Contractor or Owner Making This Installation) M f,~ E uO~['~D OW This inspection request will not accepted the ~J DIM ~ State Board unless ss proper inspection fee is is enclosed. Minnesota State Board of Electricity l CZlr 1954 niversity Ave., St. Paul, Minn. 55104-Phone 645-7703 / S~~ 7 REQU FOR CHECK BELOW EST WORK COVERED BYELECTRICAL THIS REQUEST INSPECTION 2 5 6 7 9 Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For Home ❑ ❑ ❑ Range 11 Temporary Wiring ❑ Duplex 13 11 El Water Heater ❑ Lighting Fixtures ❑ Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑ Commercial Bldg. ❑ ❑ ❑ Fumace Silo UNoader ❑ Industrial Bldg. L' Gonditi er L' Bulk Milk Tank 11 Farm Other Rereers# COMPUTE INSPECTI E Service Entrance Size: *%IN Fee Feedersd:Subfeeders: # Fee Circuits: # Fee 0 to 100 Amps- 0 to 30 Amperes 0 to 30 Amperes 101 to 200 Amps. 1131 to 100 Amperes 31 to 100 Amperes Above 200_Amps. Above l00 Amps. Above 100 Amps. Transformers 11 Remote Control Circ. Partial or other fee Signs Special Ins ection Minimum f -'k" 9 Remarks TOTAL E 1, the Electrical Inspector, hereby certify that the above inspection has been made. 7' (Rough-in) / Date (Final) , I , pate fl 7 This request void 18 months from lllllp~ _m37 This requess void 18 months from R 65689 Date of his Request _!Z 1, as 93licensed Electrical Contractor ❑ Owner, do hereby request inspection of the above electri- cal wiring installed at: Street Address or Route No. JS 70? ic4ey^ew dyirz,;e, City Section ' Township Range ~ County . Which is occupied by G iea) 2 sfI._e6J~Y(i1 (Na a of occupant. Is a roughin inspection required on this job? No O Yes) Ready Now Will Call ❑ Power Supplier ~~c1 Le(Address /Fzzhj!~IL, 41, Electrical Contractor Contractor's License 1140. 7 (Company Name) /,A ~j~ Mailing Address /F7 r--I- ,fJ!/1s11/ 4 Ae. (Eleotri al Con acto}'~~°wnerr akig(~Installatlon) Authorized Signature 40:&& //~1_°1~R Phone No. 15e3.2 fJ (EI a ontraptor or Owner making This lm allatlan) 5 ~ This inspection request will not he accepted by the UATE BOARD ~s tt ®State Board unless proper inspection fee is enclosed. sota tate Board o i 954'~Jrtiversity Ave:; 645-7703 REQUEST FOR ELECTRICAL INSPECTION a~ R 6 5 6 8 9 CHECK BELOW WORK COVERED BY THIS REQUEST Type of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For Home 11 ❑ ❑ Range Temporary Wiring ❑ Duplex - ❑ ❑ Water Heater Lighting Fixtures ❑ Apt. Bldg. ❑ ❑ ❑ Dryer Electric Heating ❑ Commercial Bldg. ❑ ❑ ❑ Furna gj)- 50o UNoader ❑ Industrial Bldg. ❑ ❑ ❑ Air Co ` n Bulk Milk Tank 11 Farm [E] ❑ ❑ Lpput pLisi Other ❑ ❑ ❑ Hehers He ers~ COMPUTE INSPECTION FEE BELOW . Service Entrance Size: # Fee Feeders&Subfeeders: # Fee Circuits: # Fee 0 to 100 Am s. 0 to 30 Amperes 0 to 30 Amperes 101 to 200 Amps. (j 31 to 100 Amperes 31 to 100 Amperes Above 200_Amps. Above 100 Amps. Above I00 Amps. Transformers Remote Control Circ. Partial or other fee Signs Special Inspection Minimum fee Remarks TOTAL F E 9 65 I, the Electrical Inspector, hereby certify t the a ins{ectio has been m (Rough-in) %7~t%bldAate (Final)e ~ti d `1Da~te .3 This request void 18 months from This request void 18 months from L,Z-7 oZ - ~ 741Q7~ Date of this Request y 9 - 1, as Licensed Electrical Contractor ❑ Owner, do hereby request inspection of the above electri- cal wiring installed at: L a IS -3 U\A..o akia.)~ 3~J, Street Address or Route No. : 5S-V CJ1 "Sft4l IAIZ City Section Township Range - County AL crr )4 ~ Which is occupiedby(lrn<,z wmoll\ Q n E~na'"v Rr"idprS (Name Ot'll t) Is a roughininspection required on this job? No O Yes Ct}~ Ready Now Er Will Call ❑ Power Supplier .k . 0~ `riC Address $21- 3`~`~ S~. .µrm;nn ~pr~- Electrical Contractor r Zv%C' Contractor's License N ti9 (Company Name) Mailing Address (0,mor- 3 `r S/ (Elect,Jical ont tpr er Making Thls In latlan) Authorized Signature ~ ( Phone No. 3a2- (,_F6 (EI ilcal Contractor or Owner Making This Installation) N ~(l~ .-0 /O~ f~ p~ ~ This inspection request will not accepted the ~~CC V A Q V~ State Board unless proper inspection fee is is enclosed. wkaweseta,btatelsnarrLorx tectrtclty- 1954 University Ave., St. Paul, Minn.-55104-.Phone 645-2703 7°Z9 REQUEST FOR ELECTRICAL INSPECTIjaU 9 19 7 CHECK BELOW WORK COVERED BY THIS REQUEST T e of Building New Add. Rep. Check Appliances Wired For Check Equipment Wired For Home 91 ❑ ❑ Range ❑ Temporary Wiring ❑ Duplex ❑ ❑ ❑ Water Heater ❑ Lighting Fixtures ❑ Apt. Bldg. ❑ ❑ ❑ Dryer ❑ Electric Heating ❑ Commercial Bldg. ❑ ❑ ❑ Furnace ❑ Silo Unloader ❑ Industrial Bldg. ❑ ❑ ❑ Air Conditioner ❑ Bulk Milk Tank ❑ List List Other ❑ El Q Others} Others Aere l11 Here COMPUTE INSPECTION FEE BELOW Service En ce Size: # Fee F S e Fee Circuits: # Fee 0 to m s. s 0 to 30 Amperes 101 to 200 Am s. 3 0 31 to 100 Amperes Above 200 Amps. A e 1 Above 100 Amps. Transformers Remote Control Circ. Partial or other fee Signs Special Ins ection Minimum fee $5.00 Remarks , 66ct-+P TOTAL FEE 1, the Electrical Inspector, hereby certify that the above inspection has been made. (Rough-in) Date ea 4 (Final) Date (o ( "7 r( This request void 18 months from _ CITY EAGAN PERMIT ~k03L3 3830 Pilot Kribb Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55122-1897 Permit Number: 0 2 5 8 0 0 (612) 681-4675 Date Issued: 06/12/95 SITE ADDRESS: 4572 CHES MAR DR LOT: 2 BLOCK: 3 CHES MAR 3RD P.I.N.: 10-17102-020-03 DESCRIPTION: (ROOFING) Building.Permit Type SF (MISC.) Building Wo.r.k Type REPAIR .7 j t i. _ _t 1.. ~ l S' I 3 S 1~ REMARKS: FEE SUMMARY- VALUATION $4,000 Base Fee $87.25 Surcharge $2.00 Total Fee $89.25 CONTRACTOR: - Applicant - ST. LIC. OWNER: REGAL BLDRS & REMODELERS 17718305 0001168 MARTYNENKO VICTOR 1840 ENGLISH ST 4572 CHES MAR DR MAPLEWOOD MN 55109 EAGAN MN (612) 771-8305 (612)454-2561 I hereby acknowledge that I have read this application and state that the information is correct and agree to compli with all applicable State of Mn. L Statutes and City of Eagan Ordinances. q APPLICAN RMI E SIGNATURE ISSUED BY. SlIGNANURE INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: BUILDING 3830 Pilot Knob Road Permit Number: 025800 Eagan, Minnesota 55122-1897 Date Issued: 06/12/95 (612) 681-4675 SITEADDRESS: P.I.N.: 10-17102-020-03 APPLICANT: LOT: 2 BLOCK: 3 4572 CHES MAR DR REGAL BLDRS & REMODELERS CHES MAR 3RD (612) 771-8305 PERMIT SUBTYPE: TYPE OF WORK: SF (MISC.) REPAIR DESCRIPTION (ROOFING) INSPECTION DATE INSPTR. INSPECTION TYPE DATE INSPTR. FINAL F- L A . CITY OF EAGANQ lffq 00 3830 PILOT KNOB RD - 55122 `t 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New Construction Requirements Remodel/Repair Requirements # 3 registered site surveys # 2 copies of plan # 2 copies of plans (include beam & window sizes; poured intl. design; etc.) # 2 site surveys (exterior additions & decks) # 1 energy calculations * 7 energy calculations for heated additions # 3 copies of tree preservation plan if lot platted after 7/1/93 Yes _ No DATE: CONSTRUCTION COST: DESC ON OF WORK: STREET ADDRESS: LOT r _ BLOCK A SUBD./P. I. D. PROPERTY Name: 16/.ror ,A,^ '~hone OWNER T Street Address' 4 Clz~ c c 42a- City: . State: Zip: CONTRACTOR Company: J U11 Phone v 47- V- Street Address: -/ft v f w c h License / j City: Gt~~ State: &I P,- Zip ARCHITECT/ Company: Phone ENGINEER Name: Registration M Street Address- City: State: Zip: Sewer & water licensed plumber: Penalty applies when address change and lot change are requested once permit is issued- 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. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received Yes No Tree Preservation Plan Received Yes No CITY OF EAGAN Ng. 5145 f 3795 Pilot Knob Read Eagan, MN 5SI22 PHONE: 454-8100 BUILDING PERMIT APPLICATION Receipt # To be used for SF Dwlg & Garage Est value 60,000. Date 4-4 _ 19-79 Sit. Address 4572 Ches Mar Drive Erect M Occupancy R3 Loth- Block 'A sec/Sub. ac Mar 33-a Alter ❑ Zoning Rl 10 17102 020 03 Repair ❑ Fire Zone 3 Parcel # Enlarge ❑ Type of Const. V c Name Grosz & Ielunan Move ❑ # Stories Address P.O. Box 1211 - Demolish ❑ Front 54-- ft. city B' Ville ph, - Grade ❑ Depth 36- ft. Approvals Pees W Nome SCUM i Assessment 4 2 79 Permit 154.50 _ Address Water & Sew. Surcharge 30.00 Ci Phone Police Plan check 77.25 Name Pertineu Plan Senn Ce Fire SAC 525.00 =Z Address7101 Hunr_ 65 N.F._ Eng. Water Conn. 270.00 <w Ci Mpls 55432 phone 571=9080 Planner Water Meter 60.00 Council lead unit 75.00 1 hereby acknowledge th*mad plication and state that Bldg. Off. the information is corre ply with II applicable ARC Total 1.191.75 State of Minnesota St O es. Signature of Permitt A Building Permit is issuebman on the express condition that oil work sholl be done i rdan wwiithfal lice to of Minnesota Statutes and City of Eagan Ordinances. Building Official DATE ~i✓7 7/ BUILDING PERMIT APPLICATION Include 2 sets of plans, 1 site pl n w/elevations and 1 set of energy calcuations. To be used for i~64l Valuation Site Address: Lot Block 3 Sec. //Sub. 3 Parcel Number . /71e 2- C3a+D o3 Owner Q b4 Telephone 42-- ?9 9.Z9 Address MA r- Contractor Telephone Address Arch/Eng. ,&Awlir'Aw Telephone ~7I - 9a 0 Address / OFFICE USE ONLY Erect Occupancy Y Alter Zoning Repair Fire Zone Enlarge Type of Const. Move P of Stories Demolish Front _ Grade Depth Date of A rov a Initial Fees Assessment Permit STY Water/Sewer Surcharge so ~ Police Plan Check 77 Fire SAC ko`~ s Engineer Water Connection Planner Water Meter j d Council Bldg. Off. i A.P.C. TOTAL - QivLifi" . -pe enr. r •~Ylm q.: _ Burnslille, MN 4037 DELMAR H. SCHWANZ 7l LANDSURVEYOR R"Wetea Uheer laws of The State of Ml he%Oa 2978 - 145TH STREET W. - BOX M ROSEMOUNT, MINNESOTA 55088 PHONE 612 423.1769 SURVEYOR'S CERTIFICATE I 1 1 ' - - - 46 .,f i~' Black 3a CHAS MAP Tl.IRD A. DI? r0r, _ . :,n I ? ly and o record i? _.C Jt i r.['t of La': County CC,.,m.:1', a.iK :iL3 1 ,....:-.J T..._ne_>O ta. March 1- r MiNNESOTAREG!STRATIONN0.8625 EXTERIOR ENVELOPE AVERAGE `U" COMPUTATION OWNER G(?D5 Z 4 L EfHM/l Q SITE ADDRESS ~1:572 6yE5 My R I e1t1,E CONTRACTOR Grosz & Lehman DAM--I-4- 7? PHONE 452-3929 Determine working square footage of each. 1. Total exposed wall area 3Z2- sq. ft. x .17 = 3 2. Total roof/ceiling area sq. ft. x .05 = ~I 5 Total exposed wall area above floor = a. Total wall window area b. Total door area ?cam c. Total sliding glass area ~c3 d. Total fireplace mall area 75-- e. Total wall framing area (average 10%)... z 3 z f. Total net wall area above floor g. Total rim foist area /zv Total exposed foundation area = /2 h. Total foundation window area i. Total net foundation area above grade Determine "U` value of each wall segment. a. / 3, x "U" -S b.- 2 X sluf; = 3.Gi h. c~ X °'Utr i. X f:Uc: 7 = 3 ............................................Total = 3 V6-', If item #3 is the same as, or less than item #1, you have met the intent of SBC 6006(c)2. Total exposed roof/ceiling area J. Total skylight area..... k. Total roof/ceiling framing area (average 107, 1. Total net insulated roof/ceiling area .GAF Determine IV valtth for each roof/ceiling segment. J. A/ X IV? k. X U'' 1. X ,;Ur, 4 .........................................Total = i5-37571' If total of 04 is the same as, or less than #2, you have met the intent of SBC 6006(c)l. Alternate Building Envelope Design To utilize the total envelope systen: method, the values established by the sum of items #3 and #4 shall not be greater than the sum of items #1 and #2. 1. + 2. - 3. + 4. _ Storm Sewer Trunk Ches_Mar_3rd - Block 1, Lot 1 338.62 Block 2, Lot 1 354.00 2 320.32 3 313.04 4 313.04 5 364.00 Block 3, Lot--,l 364.00 - C 347.65 Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - - - For Office Use Permit City of Ea a~ d I Permit Fee: l - 3830 Pilot Knob Road Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I I I 2010 RESIDENTIAL BUILDING PERMIT APPLICATION Date: _"5_f o Site Address: !11'7 2, T)r-, Tenant: G,%- e, e- 1A ea- XC` h 1 Yu"e &4ko Suite RESIDENT/OWNER Name: G4 4e-`L0' W6r t-7Y Phone: Address/ City/ Zip: ' 7Z C L 5 e- Z-9 Applicant is: Owner Contractor TYPE OF WORK Description of work: lY'~ BTl' f eo Construction Cost: ~0B Multi-Family Building: (Yes / No y) CONTRACTOR Name: L~ /r S d License c;70 Jrv 7 f~_9.7 'Ga Address: ,~C City: State: Zip: Phone: Contact: Email: 0 j-c S 2 ",f-5 " G' 44` 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 & Water Contractor: Phone: 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 the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One 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. www_gopherstateonecall.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 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. x fee 4 x Applicant's Printed Name Applicant's Signature Page 1 of 2