3872 Cinnabar DrBUILDING PERMIT
AI? 4285
Receipt # ??T
To be und fw Dat e , 19
Site Address - Erect ? Occupancy
Lot Block Se __ Alter ? Zoning
Parcel # C:ik Repair ? Fire Zone
Enl
r T
of Const
ge
a ? .
ype
o
c Name Move ? # Stories
W
Z
O Address- ' Demolish p Front ft.
Cit Phone e ? Depth - ft.
? Name
0
?? Addre
Name _
Address
Assessment _
\Woter & Sew.
zlica..
Feea
Permit
Surcharge
Plon check
SAC
Water Conn. _
Water Meter
Council
I hereby acknowledge that I have reod this opplicotion and stase that gldg. Off.
the information is correct ond agree to cornply with oll opplicoble . '.
State of Minnesota Stotutes and City of Eagan Ordinonces. APC Total
Signoture of Permittee - A Building Permit is issued to: on the express condition that
all work sholl be done in occordance with all applicable Stote of Minnesotn Stotutes ond City of Eogan Ordinances.
Building Official ?
CiTY OF EAGAN
3795 Pilot Knob Rood Eagon, MN 55122
PHONE: 4548100
Pamk # pah IMwd
Plumbing
_ Mechanicol
INSPECTIONS DATE INSP. RoupF-ln Finol
Footings ;?- Dote Irop. Dafe Inap
Foundation Plumbin9
Frome/ins. Mechaniool
Final
7? I
r7
?
CITY OF EAGAN
? 3795 Pilot Knob Road
Eagan, Minnesota 55122
Phene: 454-8100
:TRATI'.' ; _ PERMIT
No. ?n
Date: -` uzy 27 1977 Receipt No.:
Single
Site Address: Residential
Lot - 8fock 1 Sub/Sec. ?-..4
Multi Res.. Comm./Ind.
Ncme ".`r,17e?,.,,? ?u-s
.
0
; Address _
O
City FaQdn Phone:
ame ''redrickson liear_incr7 & A/c'
? Address
?
City 1gan Phone:
This Permit is issued on the express condition thot all work shall be
Minnesota Statutes and City of Eagan Ordinonces.
New/Alter./Repalr. Cost of Installation
Permit Fee 2n nn
Surcharge
Totol
done in accordance with oll applicable 5tate of
Building Official
? CITY OP EAGAN
. 3795 Pilot Knob Road
' Eagan, MinnesoM 55122
" Phone: 454-8100
PERMIT
Dote: .TUly 21, 1977
72 Cinnabar Drive
Site Address:
Lot Blxk i Sub/Sec.
CG 9
No.
Receipt No.:
Single
Residential
Multi Res., Comm.llnd. I
Name _'- ? son New/Alter./Repoir `
.
; Address Cost of Instollotion -
O
City '-4an Phone: Permit Fee .. 00
` Name ° nz-Ry,•_~ Plumbir.c{ f; i:aating In-. SurcFwrge ' S^
g Address '' 745 50. Rohert Trail.
e
0
City 5-: :?. . Phone: Total
This Permit is issued on the express condition that all wark sFwll be done in accordance with oll applionble State of
Minnesota Stotutes ond Ciry of Eagan Ordinances.
Building
Reoeipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN Fes 'p o
Fill in numbered spacea S/C -SO
Type or Print /eyibly Tot.
1. Date 2. Installation Cost
3. Job Address Lot Blk. ' Tract
4. Owner
5. Contractor j
Phone
6. Address -';?
7. CitV
8. Building Type: Residential ?
9. Work Description: New ?
10. Describe
11,
State Zip
Commercial ? Institutional O
Add ? Alier ? Repair O
Type
No, Equioment 8TU - M. Ea.
Forced Air No. Equiument CFM
Ai
H
li
Mfg. r
and
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed :
for
Rou9h Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAGAN Remarks
Addition CEDAR GRQVE #g Lot 3 81k 1 Parcel 10 16708 030 Ol
owner? :)?? ?i . r1 it'.< .?,'-? r.. ?•vrc E street 3872 Cinnabar Drive State Eaqan. 1rIId 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SUFiF. 1978 1035.45 103.55 10
STREET RESTOR.
GRADING
SAN SEW TRUNK 1968 55.1?i 1.83 30 3b.86 A004958 10-17-77
* SEWERLATERAL 1975 1,289.38 257.87 S 15.77 A004958 1- 7- 7
*Wat. Lat Stubs i4r-
1975
5
WATERMAI N
LATERAL
WATER
WATER AREA
STORM SEW TRK 1976 279.12 55.82 5 167.48 A004958 10-17-77
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. p4 ? _
SUILDING PER.
SAC
PARK
_ WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eugon, MN 55122 DATE:
Zoning: No. of Units:
Owner.
Address:
Site Address:
Piumber: "
Meter No.: Connection Charge: ?
Size: A
unt D
i
cco
epos
t:
Reader No.: Permit Fee:
I a9ree !o compiy with the City of Eagan Surcharge:
Ordinances, Misc. Charges:
Total:
BY Date Paid:
DoYe of Insp,: - Ins
p•:
CiTY nF EAGAN
3795 Pilot Knob Road
Ec?gan, MN 55122
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units:
Owner:
Address: -
Site Address: -
Plumber:
I agree to aompiy with the Gity of Eagan Connection Chorge:
Ordinanees. Account Deposit:
Permit Fee:
Surcharge: _
By Misc. Chorges:
_
Date of Insp.: - - Total:
Inso.: Dote Paid:
This reql•est void 18 months from ,
- O 77466
Date of his Request
I, asLicensed Eleetric Contractor OOwner, do hereby request inspection of the above electri-
cal winng installed at: , Street Address or o. L A/ City ?V
? q
Sectio? gow2t Range County iwR,
Which is occupied by 6-.?-J? ?
(Name ot Occupant)
Is a roughin inspection required on this job? No ? Yes,Et- Ready Now ? Will Ca1LK
Power Supplier Address
Electrical Contr? Contractor's LictABUAl- i
0
Mailing Addre
( I tractor or taliation)
AuthorizedSiQnaturennnv vrninoir+it Phoneg6R 9_r. () 2 A
Minnesota State Board of Electricity
19F4 University Ave., St. Paul, Minn. 55104-Phone 645-7703
aGni 1=cT GnQ Gi Gr-rRirnI IN4ZPF(`TIC1N
Home 29 U lJ Range
Duplex ? ? Water Heater
Apt. Bldg. ? ? ? Dryer
Commercial Bldg. ? ? ? Furnace
Industrial Bldg. ? ? ? Air Conditior
Farm ?
- ?
- ?
- List )
nrh..rQ L -y
Silo Unloader
Bulk Milk Tank
cITr oF eacaN
3795 Pi1M Knob Raad Eogan, MN 55122 N? 4 2 8?
PHONE: 454-8100
?-s?
BUILDING PER MIT APPLICATION $36,000. Receipt # --
To be used for Sin¢. Fam DWJ.e. & GaTe. Dore °^il 26 , 19?? .
Site Address 4me"- 3872 Cinnabar Erect [j Occupancy I
Lot 3 Block 1 Sec/Sub. CG 9_ Alter ? Zoning R1
Pa??l # Repair ? Fire Zone _
E
l
r
? T
e of Const
n
a
ge yp
.
w Name ROn W1eC2oYek Move ? # Stories
3 Address 1726 E. Maryland Demolish ? Front fr.
?
City
Phone
Gmde ?
Depth ft.
? Carl Tollefson Approvals Fee:
p Nome
?
?? Address 11816 FI t?i
I- r:... Annla Vnllnvot.LSL. (? R74
Name _
Addres5
I hereby ocknowledge thof I have read this application ond stote thot
Yhe infortnation is correct and agree to comply with all apPlico41e
State of Minnesota Statu j' a? Eagan ances. ?
?'.' , s?-lili.
Assessment -
Water & Sew.
Polite -
Fire
Eng.
Planner _
Countil -
Bldg. Off. -
APC
Permit 108 _ OQ
Surcharge 18, SO
Plan check
SAC 475_00
Woter Conn. -230,Q0
Water Meter 60-0
.Q
Totol I ?
Signature of Permittee I
A Building Permit is issued ro: Car-l Tgllefato R on the express condition that
all work shall be done? /in?/?/ecordanc wi all applicoble Stote of Minnesota Statutes and City of Eagan Ordinonces.
Bwlding Official -_.?.._-?2-P 1 ??T ?
(1.. :..
Nb?#A&
Dates
?--
BUIIJI't?G PiRMIi At'PLSCATI0"1
LOT BLOCK I ADAT;IQN ( (C3G? J/ (' ''/
Pt1i:CEL & SECTIOil INR3ER IF UiiPLATTEil
.11DllRESS OF PAn^.CEL .,} iJ ?,? ( <</) I0,4 66/ ///F'
70?ETNC '?,I ?OCCUPAIVCX (. USE?S? / l
'a'CL7' ,
?
1-]STISAtA2rD COS_
I? Z/? ` l l D l? W/ E C. Z.[1 ?? A TEL^PHOF1E iVO. ',-2 3
A-DilF: 5S
/?_ -? r '/
cotrTz.?c?F l I IdJ?C'??d !v TELEPSOEdE :10. ?f Y
?wn:Z ,s 1? v /?? Znl_-? --1y_ / k _IA4/114
r/
YJOtee Include site plan, building plans, and energy calculations with tlii_s
Gpplication
Signed
DP,ICz USE
VAT.iJifl'T?1: ? b?ll o??
SAC
Y7A^z'3.2 CO:Ti.TEC^SO:T
Wa'1TPiA !SI;^1ER
SiUILD2PIG PEP.tdIT FEE
P,URCHFIRGE FL+Y.'
FI,E1.i C't.P.CK FEE
PAFtIL DEDICI1TIO14 rrE
pTua^',R
TOTF3L*
/JO
or^?6 pO
lAd ?
. ?
1z
--v?
FPPP.OV.'2LS:
A.°.SE9S;IE::T CLEt.iC BUILDIidG DEPT
-a-
T.'7F?'.`ER & SWER DFPi. FI?L DEPT
POLICE DEPT
PFII2IC DEPT.
Toilefaan B*iders Inc. Or.10622
179-75
? •
F. . JACKSON
D BURVEI(OR
R[61lTHRlC UND[N LA • OP OTAT[ OR MIHNiWTA
LIC[N6[D KY OROINAN OF C17Y O! MINNlAlOUS
727-3434 ?
9616 EAST SSiq STREETS Gl] 1 ?rl i,i?.• ?
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1 XiREBY CEq Irl' TXAT TX[
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Lot 3,1Iock 1,Cedar Grove Na. 9, ?
Dakota Csunty,Minnesota.
AS SVRVEYE6 BY NB THIS SCI1. pAY or AprLl. p l
- ?
-,? --?
l??
/
1 I
s ? ??O H
-, n D, fGf. Eyz,s 7t'
ui?p;n?ik+nlldilk
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:;9??'a'F,a??'?st?'?d.:, ?p?i?;r?¢,?,?,??y
' ? ?' ? - ciiy of eagan
MEMO
TO: DIANE DOWNS, UTILITY BILLING CLERK
FROM: ED KIRSCHT, SR. ENGINEERING TECHNICIAN
DATE: AUGUST 23, 1993
SUBJECT: S7REETLIGtiT ENERGY COSTS-CEDAR GROYE NO. 9(98 LOTS)
This memo is to inform your department to begin to invoice the energy costs at the single
family rate effective August 1, 1993 to the property owners in Cedar Grove No. 9 Addition.
BloCk 1, Lots 1-13 13
BIOCk 2, Lots 1-5 5
18
The City is currently being billed by Dakota Electric for streetlighting in the above listed
subdivision.
Edward J. KrSCht
Sr. Engineering Technician
cc: Mike Foertsch
EJK/je
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN
3830 PI651 681-46 5 55122
l? (o
New Constrvction Reauirements
Remodel/Revair ReauiremeMs
? 3 registered sMe surveys showtng sq. ff. of lot, sq. k. of house ' 2 copies of plan .
and all roofed areas (20% maximom lof coveraae atloweA) I 1 sef of energy calculatfons for heated addNions
? 2 copies of plans (shdw beam 8 window sizes; poured fnd. design; eic.) ; 1 sMe survey tor exterior addBions 6 decks
7 set M energy calculattons .
> 3 copies of tree preservalion plan N loi platted aRer 7/1/93 1A?
DATE: YJ "? I 1'? f CONSTRUCTION COST: VV o
DESCRIPiION OF WORK: ?PCt/ {)'?? (t' IF r /F I S4fff\ JA""J
STREETADDRESS: 3e6-7--Z- C?,nc,?
LOT: -3 BLOCK: 1 SUBD./P.I.D. #: ? U V U\J
Name: -D oc,/ t 5 0 20Yq.Q- phone(061 '(a
PROPERTY Last First ?
OWNER ?j
Street Address: J S'7 2- C t NAN A b);-r f/ 7?/-
City Liqflxt "j State: m N Zip: SS / L Z
- Company:/4"ryicRrJ D? U'?A 1.0?Ajt,#'S Phone #: 6 /Z -7c)7 -o5g
(area code)
CONTRACTOR p
Street Address: ) 2-24-1 tJ 1 C p 1 \ 0" ? e• J• Ucense # 2"'q 3$3 Exp, 3/,WW
City 6 v-'(nj 5vi( 6- State: rqN zip: S5 33-7
ARCHITECT/
ENGINEER Company:
Telephone #: area code (
Street
City
Sewer 8 water licensed plumber (reautred for new consfructlon onlv):
Name:
Registration
State: Zip:
Penalty applies when address change and lot change is requested once permk Is Issued.
I hereby acknowledge that I have reqd this applicatlon, state ihat the information is correcf, and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances. / 1A
Signature of AppBcant:
OFFICE USE ONLY
. Certificates of Survey Received _ Yes No
- 1?1? ?
Tree Preservation Plan Received _ Yes _ No , Not Required
(? o (e qf? 9
) 1)
1
16 RESIDENTL4L BUILDINC
Permit Application
City Of Eagan
3830 Pilot Knob Raad, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
New Construction Reauirernen4 RemodeUReuair Rcnuirements Office Use OnN
3 registered sRe surveys shaxirg sq R ot lot sq. fl of house; and II roofed areas 2 copies of plan _ Cert of Sarvey Recd
(20% maximum lat coverage aliowed) t set of Energy Cakulations for heatetl additions _ Tree Pres Plan Real
2 copies ol plan showing beam 8 window s¢es; poured found desgq etc. 1 site survey for additions & decks _ Tree Pres Not Reqd
lsetafEneryyCalalations qddkon - indiceterfon•sitesepticsysfem _ On-siteSeptlcSystem
3 copies of Tree Preservadon Plan d lot platted after 711193
Rim Jaist Deq10p1ians seleclion sheet (bldgs with 3 or less unb
Date / ?
SiteAddress Construction Cos[ (42, ) {J /rr/" 7 b
c- UniUSte #
Description o[ Work / Q
Multi-Family Bldg _ Y_ N ?-
Fireplace(s) _ 0_ 1 _
PropertyOwner Telephone#(?^'757
Contractor
Address
State City :?OAZ_r
Zip ' Telephone # ) e
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential VentllaGon Category t Worksheet . New Energy Code Worksheet
(dsubmissiontype) Submitted Submittad
• Energy Envelope Calculations Submitted
Licensed Plumber ' 1J LLJ 11 Telephone #(
nnechanical Contractor AUG 0 7 200 3 I? Telephone #(
Sewer/Water Contractor Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work.will be in conformance with the ordinances and codes of the Ciry 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}tAe case of work}w44ich reqyitg a review and
approval of plans.
Ta/?? ;S
ApphcanYs Printed Name App icant's Signature
(o 6 d.a3
2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
s0
Date 31 I 0_
Site Street Address 3?i 72- G,?r+aYr.il IJl" Unit #
6S l 2io zugD
Property Owner -:Y Tra &'}* --<"3 Telephone #OSZ ) LIS ZS 19
Contractor Telephone # ( )
Address City State Zip
The Applicant is: j? Owner _ Contracfor _Other
Alterations to existing dwelling $ 50.00
X-Add plumbing fixtures.
If you are only installing a water softener and/or water heater, the fee is $15.00 plus the
state surcharge - see next section.
_Septic System Abandonment
_Water Turnaround (add $121.00 if a 5/8" meter is required)
Other.
Water Softener Water Heater $ 15.00
_ replacement _ additional
Lawn Irrigation System _RPZ _PVB _new _repair _rebuild $ 30.00
State Surcharge $ 50
Total $
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete
and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the event a plan is required to be reviewed and approved.
Sz,?-I- k, jr,Jav?<Zr.J
ApplicanYs Printed Name
ApplicanYs Signature
TRT0 TN?
AUG 3 1 2004 I U
6 ? aa?
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Coostrudion Reamremenis RemodellReoair Reamrements
3 registered site surveys showirg sq fl of lot, sq. ft of house; and all roofed areas 2 copies of plan
(20% maximum lot coverege allowed) ? 1 set of Energy Calculations for heated addifions
2 copies of plan showing beam B wintlow sizes, au d found design, etc , 1 stle survey for addAions & decks
isetoFEnergyCalculalions ? AddiGOn-indicate'rfon-sitesep6csysfem
3 copies of Tree Preservation Plan if bt platted afler 711193
Rim Jast Detail Options selec6on sheei (bldgs wAh 3 a less uniis
'70 ds
?
Cj"? 4, / ?-tlc
Ofte
?
Cer[ tf 5untey Recd . Y. Ai
T[eePE25Pf?t1.[?ectF: ' ._'f _N_
iwePresitequited; ' ;,,.?' ,.,,?1
p.rtiRsSepGcBysiern : _Y _N
Date 9/ 3 I lOq Construction Cost ???D co
Site Address 3 ci "J 2r Glu?o,Ag pIt, (:)2- • IInidSte #
sp?GA ss 17,z.
Description of Work t3A5Fn?t?s ? -N7-k"`s"
Multi-Family Bldg _ Y? N Fireplace(s) ? 0 _ 1 _ 2
PropertyOwner T&VV f Sco"rC SwAOs00 Telephone#(1p5?) Zk 0 ?cr2-$o
0.S'2. ti. 2?5, y5'tq
COntractor
Address City
State Zip Telephone # ( )
.?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y
tee applies.
Licensed Plumber
Mechanical Conhactor
Sewer/Water Contractor
N If so, 257o plan review
•
9
I hereby apply for a Residential Buitding Permit and acknowledge that the i rmatiotrift4xlplete d accurate;
that the work will be in conformance with the ordinances and codes of?he tate of MN
Statutes; I understand this is not a pernut, 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.
Telephone # (
on A Trc,4 `
Appl a s Printed Name . Appli 's ignatu e
OFFICE U5E ONLY
Sub Types
? 01 Foundation p 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bidg
? 02 SF Dwelling CI 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Att- Multi
? 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Ait - SF
? 04 02-plex ? 10 08-plex ?'18 Deck ? 23 Porch (scree /gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ?'19 Lower Level ? 24 Storm Da? ge
? 06 04-pleX ? 12 12-plex Plhg_Yor_N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior O 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building• ? 43 Reroof ? 46 WindowsfDoors
? 34 ReplaCement 'Demolition (Entire Bldg) -Give PCA handout to appiicant
Valuation a0 d oD ?- Occupancy TZMCES System
Census Code L- 3 y Zoning ?-1 City Water
SAC Units Stories Booster Pump
# af Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const v? Width
REQUIliED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) eLo FinaUNo C.O.
_ Footings (addition) _ Plumbutg
Foundation HVAC
Drain Tile Other
Roof
Ice& Water Final _ Pool _ Ftgs _ Air/Gas Tests Final
_
? Framing _ _ Siding _ Stucco _ Stone _ Brick
Fireplace _ RI. _ Air Tes[ _ Final _ Windows
?c Insulation _ Retaining Wa11
Appraved By: , Buifding Inspector
n
-------
--------------------------
Base Fee
Surcharge (^
Plan Review
(
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Suroharge
Treatment Plant ?
License Search
Copies
Other
Total
t
Use BLUE or BLACK Ink
---For --O ffi-ce-- Use
~ tt~, I
I Permit
C
* of Wan pel.rvv 9
l Permit Fee
3830 Pilot Knob Road
Eagan MN 55122~~ Date Received:
Phone: (651) 675-5675 I I
Fax:. (651) 675-5694 1 staff. I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 5h t) Y Site Address: 7,2-, 6'1ZW R6'v- Dr, Lqjan" Unit
Name: i 1 o if ia Pn8,eA~d n) Phone:
Resident/
Owner Address/ City /Zip: Aw Af2- a AJ 67 J /a
Applicant is: Owner -Y- Contractor
i Description of work: Cr l Q
Type of Workr
Construction Cost" Multi-Family Building: (Yes No
Company: 4-1;0 I rtL., OaA,N 5:" ,CrL- Contact: q L) W S OY
Contractor Address: ~20 / Q Il City~: l)2(:tAteState: 07A) Zip: ~S l0 Phone: ~7^ o~J i J~
License 6.- ~ 3 Lead Certificate !~T 1 aS 8
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 TNo 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.oopherstateonecall.ora
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and odes 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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Build g Code must be completed within 180
days of permit issuance.
X x
Applicant's anted Name Ap can Signatu
Page 1 of 3