1379 Easter LaneMECHANICAL PERMIT DATE: 5/30/91
RECEIPT: 101588
SITE ADDRESS 1379 EASTER LANE Unit # Permit M 13051
L 3 B 1 Sect/Sub. WILDERNESS RUN 5TH
BURNSVILLE HTG . & A/C-894-00 05 REPLACE A/C UNIT
INSPECTION DATE INSPECTOR OTHER
FRAMING
ROUGH PLBB.
ROUGH HTG.
INSUL
FIREPLACE
FINAL HTG.
FINAL PLBB.
UNIT FINAL
CERVOCC
COMMENTS
MECHANICAL PERMIT DATE: 5/30/91
RECEIPT: 101588
SITE ADDRESS 1381 EASTER LANE Unit # Permit #----L3 052
L 3 8 1 Sect/Sub. WILDERNESS RUN 5TH
INSPECTION I DATE I INSPECTOR I OTHER
FRAMING
ROUGH PLEB.
ROUGH HTG.
INSUL
FIREPLACE
FINAL HTG.
FINAL PLEB.
UNIT FINAL
CERVOCC
CITY OF EAGAN Remarks
Addition Wilderness Run 5th Addition Lot 3 Rik 1 Parcel_
Owner e Street 1381 Easter Lane State
l c.?.tvfiQ. N ° /n C1. W,j .. r : 1-77 1), 1,
10 84354 030 01
MN 55123
Der In/* 10.
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 1973 132.60 6.63 20 PAID
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA Puld 4th Water c oninectior, 74
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. $560.00 12172 11-18-74
BUILDING PER.
SAC 800.00 12172 11-18-74
PARK
VILLAGE OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.: 1650
Eagan, MN 55122 DATE: 11/20/74
Zoning: PUD No. of Units: 2
Owner:
Address
Site Address: 1379 & 1381 Eas ter Lane
Plumber: Thompson Plumbin Co.
Meter No..' 76 Connection Charge560.00 pd
Size: Account Deposit:
Reader No. Permit Fee: /00Cl?r1.?? -?
I agree to comply with the village of Eagan Surcharge: ..-.d
Ordinances. Misc. Charges: 83.40 billed 11/:
/ Total:
BY4 `?? Date Paid:
Date of Insp.: Insp.:
VIMAOE•QE EARAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.: 2410
Eagan, MN 55122 DATE: 11120/74
Zoning: PUD No. of Units: 2 -
Owner: tie s.ll r t i?1' r.,
Address:
Site Address: 1'179 r, J 'Aril t: + Xana
Plumber: Thempsan °T ""'b" ^^ CO-
I agree to comply with the Village of Eagan Connection Charg$00. D--QA
Ordinances. Account Deposit:
Permit Fee; zl t' -.4..e4 6u
Surcharge:
By: Misc. Charges:
Date of Insp.: Total: -
Insp.: Date Paid:
3l9i i'l iot Ill.oo '.iaCl q??
LL F" .. ; i;inecota- 55122 ?J
PEF]VS'P NO.: 535
Ine City of Ea,,; n hereby ants to Thompson Plumbing Co.
of 12201 Minnetonka nlvd.
s PL[JMSING Permit for: (C,•mer) Marell Construction
1375-77 and 1379-81 Easter Lane and
at 1396-96 E. Sigfridt St., pursuant to application dated _ 11/20/74 -
billed
Fnc PK*Kz dated this 24_day of n7ay_ a 1° 7a
3.00 s/c
Building inspector
achanical Permits:
2:1 Total:
CI'IY vi EACAN
3795 Pilot K hob Road
Eagan, Minnesota 55122
PERhST NO.: 604
The City of Eagan hereby grants to Ray N. Welter Heating & A/C Co.
of 4637 Chicago Ave. So.
a HEATING Permit for: (Owner) Harell Constraation Co.
at 1379 & 1381 Easter Ln. , pursuant to application dated 11/15/4 .
Fee Paid: $40.00 dated this 19th day of Nov. 19 74
1.00 s/C
Building inspector
Mechanical Permits:
Bid Total:
This 1;equest void 18 months from ?? BY y 0-46 o / 7
OG93
Date of this Request P 9245
I, as Licensed Electrical Contractor ? Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No, i 3 ?i 1 €-u-L C._ n Cit
Section Township Range County %1t4
Which is occupied by
Is a roughin inspection required on this job? No D Yes II Ready Now ? Will Call ?
Power Supplier Address
Electrical Contractor d• ?,,o ?,J ?"1 Contractor's License No35'?k
(Compa Name) -
Mailing Address 1-4s'.0 .4;,
Authorized Signature
(Electrical Co ractor or Owne
MTE BOARD COPY
or ow Kling I nls Innanation)
Phone No. ?PZJYO_
Minnesota State Board of Electricity
.1654 University Ave., St. Paul, Minn. 55104-Phone 645.7703
REQUEST FOR ELECTRICAL INSPECTION
CHECK BEL03!!!VORK COVERED BY THIS REQUEST
-Z?' e6 y.37
p 9245
Type of Euilding New Add. Rep. Check Appliances Wired For Creek uipment Wired For
Home ? ? Range ? Temporary Wiring ?
Duplex ? ? Water Heater ? Lighting Fixtures ?
Apt. Bldg.
Commercial Bldg. ?
? ?
? ?
? Dryer
Furnace ?
? Electric Heating
Silo Unloader ?
?
Industrial Bldg. ? ? ? Air Conditioner ? Bulk Milk Tank ?
F 11 List ) List
arm
Other ? ? ? Others}
F ere ))) Rthers?
ere ffffff
COMPUTE INSPECTION FEE BELOW
Service Entrance Size: # Fee Feeders&Subfeeders: # Fee Circuits: # Fee
0 to 100 Amps. 0 to 30 Amperes y+ 0 to 30 Amperes
101 to 200 Amps. 31 to 100 Ampe16"s-. 31 to 100 Am eres
Above 200 Amps. Above JOCL?4_Amps, Above IOQ_Am s. '?-
Transformers
Remote con 'ol '
Partial or other fee k
Signs S ecial lns cti Minimum fee $5.00
Remarks TOTAL FEE
I, the Electrical Inspector, hereby cer 'at i ins e . n has beeAmade.
(Rough-in) Date (Final) Date
This request void 18 months from
CITY of EAGAN
BUILDING PERMIT
Owner DONALD E. JESNESS
.....................................................
Address (present) ........ .. Easter Lane
1.........381 . ... ................................
Builder ..... Same
..............................................................................
Address ......
DESCRIPTION
N2 4157
3795 Pilot Knob Road
Eagan, Minnesota 55122
454.8100
Date .......12/1.3/76
454 =3858
Stories To Be Used For Front Depth Height Est. Cos! Permit Fee Remarks
Addition 16' 22' 7,000 27.00
4.00
Ai?o
or
1381 Easter Lane
LOCATION
3 1 1 1 Wilderness Run 5
This permit does not authorise 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 hasard to the health, safety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
This is to certify, lhat.._DOnald E.:...Jesness........... haspermission to erect a.......... Addition
......... ........... _ upon
the above described premise subject to the provisions of all applicable Ordinances for the City of Eagan.
-----------------....---.. Per .... ??..... .....
........................ Mayor Building InspectofnAJ
CITY of EAGAN
BUILDING PERMIT
Owner _.m.4r.Q:.'.....Q:.._6? ....:............................
Address (present) /..4.e.......?^2? .........
Builder .........°°-------------_---°°.........._°----°°..............---°-°-...............
Address ..............................................................................................
DESCRIPTION
r/
N2 .3486
3795 Pilot Knob Road
Eagan. Minnesota 55122
454-8100
Date ..[.•-.?.?.".7.1.......... _.......
Bioxiea To Be Used For Front Depth Height Est. Cost permit Fso Remarks
pGi u Zc ,
G N ' _
t{ 9 /&
ig a y
?Y
7
oz
/
/S
v '.oY e. ?E e
a_ r T-- s LOCATION /d 8-- Sd
Street, Road at other Description of Location Lot Block Addition or Tract
This permit does not authorise 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 KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
This is to certify. fhstf. ? .. ___ :z:P..... tt. `.z-°-.-°.....has permission to erect a.-_ :'.`.:?'::. `..:..:e.°.:` ?__upon
the above described premise subject to the provisions of all applicable Ordinances for the City of Eagan
......... .................. ?... .. .................... Per ................... .....'`..........-.......':....................... .. --?-.- Mayor Building Iscios
?Iggo
2007 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/coodos when pertrus are required for each unit
1,5o.-6z)
Date o9 / / ( /
Site Address
1 3 ,k/ Unit #
`
Property Owner Tele
hone # ( ??aZ) c36 / / 7 Z Sf
p
Contractor BURNSVILLE HEATING &A/C. INC.
3451 W. Burnsville Parkway
Street Address Suite 120 City
State p?
Burrisville; MN 55337 Zip Telephone # ( ?I ? ? 4?69 f
Bond #:?? L7 S 07 7/3 Expires: !fie U
The Applicant is Owner Contractor Other
,d
_
Fire repair (replace burned out appliances,
du
ctwork, etc.) $ 90400
This fee applies when extensive mechanical repairs are made to a building.
Add-on or alteration to existing dwelling unit $ 50.00
furnace -Additional replacement _ New
air exchanger
air conditioner
heat pump
other
State Surcharge $ .50
Total $)
I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and
be in conformance with the ordinances and codes of the City of Eagan and with ical Codes; t
permit, but only an application for a permit, and work is not to start without a permit; that ,41e wor wil
approved plan in the case which requires a review and approval of plan
G
/Lc
Lt JD/ 2 `L /Lc
LLctCf
I'S
Applicant's Printed Name App cant's Signature
w?
7iTtYe L?
1 9 2008
2007 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/condos when permits are required for each unit
!50- S:_0
Date 10
Site Address R) <:5 A S Unit #
Property Owner V-?l?y? 2 S Yl S 5 Telephone # ( c3 6o
Contractor BURNSVILLE HEATING & A/C, INC.
345 -w umsvl e a way
Street Address Suite 120 City
Bumsville, MN 55337
State
hone #
Zi
T
l { (G,/
p
e
ep
,rte -1 1
Bond #: TJ 8 S L • ?. V - 3 Expires: a-d 0
The Applicant is Owner 7y- Contractor Other
Fire repair (replace burned out appliances, ductwork, etc.) $ 90.00
This fee applies when extensive mechanical repairs are made to a building.
Add-on or alteration to existing dwelling unit 50.00
- furnace -Additional -Replacement _ New , ?9
?
- air exchanger
diti
i O ?J
00.
2
vv
r con
_ a
oner e g ?oO
heat pump ,
5 ?aR
other
State Surcharge $ .50
Total $
I hereby apply for a Residential Mechanical 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 with the Mechanical Codes; that I understand this is not a
permit, but only an application for a permit, and work is not to start without a aftithat the work w e accordance with the
approved plan in the case ofWC?r`k which requires a review and approval of plans
(A S0. r? clcC?1U C ?GtA-.rrt r
P
Applicant's Printed Name Applicant's Signature
MASTER CARD
LOCATION - Gt f (i [ F- , 1e;f7 `1 - Ar-/ -?-
OWNER r? / L Qh S 7--
STRUCTURE AND !-
LAND USED AS ?rd L a/
Permit
No.
Issued Issued To
Contractor Owner
BUILDING
PLUMBING
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
I
SANITARY SEWER
OTHER
OTHER
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING °j SEPTIC l
FOUNDATION CESSPOOL i
FRAMING TILE FIELD FT
FINAL
ELECTRICAL
HEATING
Z- 5= z DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL i
SANITARY SEWER
Violations Noted
on Back
COMMENTS:
MASTER CARD
LOCATION 1381 Easter Lane Lot 3 Block 1 Wilderness Run 5th
OWNER DONALD E. JESNESS
STRUCTURE AND Addition
LAND USED AS
Permit
No.
Issued Issued To
Contractor Owner
BUILDING 4157 12/13/76 Donald E. Jessne s same
PLUMBING
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER
OTHER
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING SEPTIC
FOUNDATION CESSPOOL
FRAMING TILE FIELD FT.
FINAL
ELECTRICAL
HEATING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER
Violations Noted
on Back
COMMENTS
PERMIT# L/Sr/tfO/ RECEIPT DATE: &-do-6(
USIDENTIAL PLUM$INCz EMIT APPLICATION
CITY OF EAE AN
3830 PILOT KNOB RD
$AGAN, MN 551 EE
651-681-4675
Please complete for:
SITE ADDRESS:
OWNER NAME: :
INSTALLER NAME
STREET ADDRESS
? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for irrigation system
JUN 2 0 200
1?3Ji? ^?ASt?A TELEPHONE #: ?&51 -L451-1- 32168
AREA CODE)
Pct rip an lY`{LCJ?2n'tw1TELEPHONE#: -(e1-7l
CITY: 1 ?1 h bC -'as- STATE: Pnr--) ZIP: acuo
Place a check mark next to the permit work type
New residential dwelling unit under construction and not ownerloccupied $ 90.00
_? Add-on, modification or alteration to existing dwelling unit, including: $ 50.00
• abandonment of septic system
• new installation/repair/rebuild of RPZ
• lawn irrigation system
• water turnaround
Nature of work: AA4i
_ Septic System, new/refurbished - $ 225.00
• includes County & Consulting Inspector fees
• requires MPC license
State Surcharge $ .50
Total $ 50-50
Reminder. Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances. It
is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal
operational and maintenance activities to the facilities constructed under thispermit within Ciiy propertylright-of-waylea Ament.
?/7J
SIGNATURE PERMITTEE
Updated 1101
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
FOR CITY USE ONLY 3 / Z= U
PERMIT # Z-3061
RECEIPT
DATE: L q
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE ]
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION
NEW CONST _
ADD ON
REPAIR
DWELLINGS &
OWNER NAME: ?d J??S M 8'S /
SITE ADDRESS: SOS ?- L-A ?
LOT: 31 BLOCK SUBD.
INSTALLER: AlirnSVllle l-IPating & A/C, Inc.
12481 Rhode Island Ave. So.
ADDRESS: savage, MN ;,;,078.1122
894.0005
CITY: ZIP:
PHONE #
FEES
ADD-ON MINIMUM $15.00
HVAC 0-100 M BTU 24.00
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS - MINIMUM 3.00
OF 1 PER PERMIT
SUBTOTAL: $ G
STATE SURCHARGE: .50
l5" D
TOTAL: $?_?
-SIGN TUBE 0 PER! EE
( 1CR ?? H" tJnl ??
i,4MMtTAiGjN#?YiSTRAGi PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
FEES
1% OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING - $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE
TOTAL:
(SIGNATURE)
CITY OF EAGAN
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
m¢IIC(k3c:?t'
FOR CITY USE ONLY 5
PERMIT # 13 05 -.2 i
RECEIPT #
DATE:
SAxA1;' PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
------------------------ -------------------------- --------------------------------------
WORK DESCRIPTION FEES
NEW CONST _
ADD ON
REPAIR
OWNER NAME: _I)D"1 1JL&.s ?_ S
SITE ADDRESS:_LZE(
LOT: BLOCK SUBD. ((/.(X¢240
INSTALLER:
burnsvme Heating & A/C, inc.
ADDRESS: 12481 Rhode Island Ave. So.
Savage, MN bbJ/b-11ZZ
CITY: 894.00:
PHONE #
ADD-ON MINIMUM
HVAC 0-100 M BTU
ADDITIONAL 50 M BTU
GAS OUTLETS - MINIMUM
OF 1 PER PERMIT
SUBTOTAL:
STATE SURCHARGE:
TOTAL:
DWELLINGS &
$15.00
24.00
6.00
3.00
$_G.\
50
$ /.1
?fxrP,
SIGN TURE PERMXTRt
GONMEROASNT?USTRTAI`S PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
-------------
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
FEES
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
?p rH $1,000 OF PERMIT FEE
PROCESSED PIPING = $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18
STATE SURCHARGE
TOTAL:
(SIGNATURE)
CITY OF EAGAN
PERMIT# O 1
RECEIPT DATE.
MWENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3$80 PILOT KNOB RD
KASM, MN 551 EE
651-6$1-9675
Please complete for: ? single family dwellings
9 townhomes and condos when permits are required for each unit
? backflow preventer for irrigation system
SITEADDRESS:
OWNER NAME:: 1 JG/J ?ES/I?L?SS
INSTALLER NAME iq P_ EA ,lam k-,c S
STREET ADDRESS: &I
CITY: I ? L-0 /j G o 71 E?`
Place a check mark next to the nermtt wnrk tvne
/j, A
Jv
/ TELEPHONE #: la,? / - ?S f 3 2159/
(AREACODE)
/-TELEPHONE* 7 (AREA CODE)
;L T AJ
STATE: ZIP: 606120
New residential dwelling unit under construction and not owner/occupied $ 90.00
/
V_ Add-on, modification or alteration to existing dwelling unit, including: $ 50.00
• abandonment of septic system
• new installation/repair/rebuild of RPZ
• lawn irrigation system
• water turnaround
Nature of work:
_ Septic System, new/refurbished - $ 225.00
• includes County & Consulting Inspector fees
• requires MPC license
State Surcharge $ .50
T
t
l $??
o
a
Reminder. Be sure to schedule inspections of alterations, i.e. water heaters, water sotteners, etc.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply withal I applicable City of Eagan ordinances. It
is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by t e City during its normal
operational and maintenance activities to the facilities constructed under this permit within City property/righ?oi-wayleaseme?tt
SIGNATURE OPRMITTEE
V ?
Updated 1/01
• • ri _ ?? . In... -3?1??0
I-OSOb fyr-: ale Avrnuc Scu`•b-
?lcc.iD?tor9 `_'lune.ol.a 55412 rr_rt, r3
DELMAR H. SCHWANZ
LANDSURVEVOR
Re91steretl Under Laws of The Stale of Minnesota
100% MAIN STREET P.O. BOX M • ROSEMOUNT, MINNESOTA 55068 • PHONE 612 4231769
SURVEYOR'S CERTIFICATE
4
Y
0
-1 L- 75
x
Z
O
m
P
O?
0
3o
I
t
!O
150
5CALF I° = 40• X I
E A
F
I horuby certify theft this is I -t.rzc. and correct rerresentati':ll of
Lot 3, Block 1, NI ID EBi;r,$S R11 NJ FIF"iii I D D I T ION, :akota Ccuntj; '0;t:: 0,
Al--,-, ..hoer,ng the locstien of a picposiuci building thereon.
1 N
MINNESOTA REGISTRATION NO 8626
SEP-23-2013 14:24 From:New Life Contracting 19524056106 To:16516755694 Pa9e:1,'1
Use BLUE or BLACK Ink
For I
I Offi-------__-r-
j Permit # 1 T~ k3
j
City of Ea ~aa
Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 ; Date Received!
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I staff: I
I
2013 RESIDENTIAL BUILDIN PERMIT APPLICATION
ry(~
Date: _ V2 Site Address: Unit !f:
p c...• Name: /✓O//~/I/1 V /C~J/ /G v S Phone:
Address (City / Zi
Applicant Is: _ Owner Contractor
Description of work: Y!
9.0
Construction Cost: Multi-Family Building: (Yes No )
Company; Ill a7?/ Me Ar. Contact /I 171 e v
Address: 4!! aar 19~1 City: lS/e P041
State:
lJS_ Zip: _ L55 aJ Phon
License 460PT / wip -ri Lead ~ertificate
It the project is exempt from lead certification, please explain wh : (see Page 3 for additional information)
~I
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:
J~IAE A'1n~tO/3)dd>`'EfEt~ ~~i~~~t~#"Yl"si~j~i`-.:o~~o~~itt a aQtt~raCer®at ft~ bl~ p~rpf~c ir~fe,trn~tior~ i9o~io~~ of
e ~Rxnrnlaflon tnyht f~ferfsrrfcrf"fu;~v a sfa1``rrsF)twQ/d.plermft tF►e Cloy fo
.~.C►!~?~l;+[~~$~! Ito ere;:#f!~d' ~t~ _
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 f r protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities, www. o herstat onecall-or
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 permi , 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 uilding C de must be completed within 180
days of permit issuanccee.
Applicant's Printed Name pp t' Signature
Page 1 of 3
i
i