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1250 Cliff Rd• . .. OFFICE USE ONLY 05/22 /90 METER # 3 51?1 9 ''2 PERMIT DATE / ? Cp g d PERMIT # 114(31 C H I P # dZ?--,--- C 7399 METER SIZE S RoG B.P. RECEIPT #--- ? -.- 7.fo - 2 p B.P. RECEIPTDATE0_!L-8 9t' ISSUE DATE _X PRV _ BOOS7ER PUMP 1250 CLI:F RD ' z SEC/SUB SECTION 34 PLUMBER: ADDRESS: 3650 ;XENNEB::C DR IP pEFiM1T REQUESTED ?'= SEWER X WATER x TAPS COMM.IIND x RESIDENTIAL NEW X EXISTING Lawn Sprinkler Meters are to be Installed Ahead of Qomestic Meters on Water Line. Credit WILL NOT be given for Deduct Meters. CITY, STATE ????645 Z " ' PHONE: I AGREE TO COMPLY WITH CITY OF i"LQ[tENCE OLSON EAGAN ORDINANCES pWNER: "% ADDRESS: 1250 CT.IFF RU ?AGACr, f?4 ZIP 551?3 CITY, STATE `' SIGN URE WHEN METER ISSUED PHONE: 'Sw-36S7 . PLEASE ALLOW TWO WORKING DAYS FOR PPOCESSING. CALL 4545220 POR INSPECTIQNS. FOR STORM ° SEWER PERMiTS, CONTACT ENGINEERING DE 1...'?? y ? ir.? ?::_ _.C/ ,' - ' ? - :R & WATER PERMIT QF EAGAN Pilot Knob Rd. i. MN 55122-1$97 • SPECIAL ASSESSMENT SEARCH SUMMARY AS OF: 05/10J1990 PROPERTY ID: 10-03400-011-02 S/A# ASSESSMENT DESCRIPT. YEAR TM RATE TOTAL ANN.PRIN. "'--- SUMMARY OF LEVIED 0.00 0.00 ****** 1990 P&I CERTIFIED 0.00 -'-'-- SUMMARY OF DEFERRED 0.40 0.00 ------ SUMMARY OF PENDING 0.00 0,00 -"--- SUMMARY OF CLOSED 0.00 Press ENTER; or F1, F4, F5, F7, F8 PAYOFF CD 0.00 0.00 o.oa . CITY OF EAGAN Remarks Addstion S .ti nn 3! ?' Lot Rlk Parcel- 7(? CI-3I owner? Street -1250 Cliff Rd. ??IIQ_ ?1L _f.?2_ scate_ E2.gariPmn 5123 ? :'C- Improvement Date Amount ` ???X'? Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. SAN SEW TRUNK SEWER LATERAI WATERMAIN WATER LATERA WATER AREA STORM SEW TRK STQRM SEW LAT CURB & GUTTER SIDEWALK STREET I,IGHT WATER CONN v ? I CITY OF EAGAN ror office sa Only # r?CO PERMIT CON 3 TRACT 830 PILOT KNOB ROAD, EAGAN, MN 55122 PRICE RECEIPT PI'IONE 454-810p DATE: Site Address 1250 CLIFF gp Lot 011 _ g?? 2 -? Sec/Sub 34 BLDG nPE WORK DESCRIPTION Res. ? ` _ New tf m Name Muk. ? Add-on Comm.- Repair ;y Address 36 KLNNEBEC DR other ? Cfty EAGAN Phoste 454-6645 RES. PLgG. ONLY - COMPLETE THE FOLLOWING: ` Name FLORENCE OLSON NO. FIXTURES TOTAL Water Closet - g3 oo ? Address 1250 CLIFF RD . s Bath Tubs -$3.00 -'? S Cay EACAN 434-3b87 Phane S"?' -?.oo $3.00 -'-- Kitchen Sink - $3.00 r...,...i..«,.?.? UrinaUB idet - $3.00 --"-- .? COMM. lIND. F? EE ? ry Tray - $3_00 A?? APT. BL DGS . - E X Floor Drains - $1.50 -"-- TOWNHOUSE ?^tll??p _ RES. RATE APLLIES ?-- Water Heater -$1,5p -- MINIMUM - REg1Bl7'j,?ligEE $12 ? Whirlpool - $3.00 . MINIMUM - COMM.IND./FEE $? ? Gas Piping Outlets -$1.50 ?- STATE SURCHARGE PER PERMIT ' ? (MINIMUM -1 PER PERMIn ?- (ADD $.50 S/C PER EACH $1,000 OF PERMIT FEE) ?ftener -$5.00 - We8 - $1 a.00 - Private Disp. - $10.00 . S1GT?ATURE OF PER Rough Openings - $1.50 ?- MITTEE U. G. Sprinkler System -$12.00 -'-- PERMIT FEE: ___Tz _-W FOR: CITY OF EAGAN WA RN'AROMSTATES S/C: SQ GRAND TOTAL: ?12_54 ? • ??'' Pl+ No L?o Mer w 1Mr1 r f'r A n/` ry1 r.?? r.r.y _. ?? - ..----°--- t V??y1 • w • ;qll-u nn edit . ,u.a. 110AD1 _ ? L ?? 1 1? ? • ? ?? , ? • ? ? ? ? ? f "h_ i • , " ?• , ?--?- ? + Q-._- ? ? f ?-;?? 1 ' ? ? ?? ? -- 4??•--- -? • t ? ? _?.?- ? ?? t ? ?"r ' • , ? ? -4-? 1 ? • ` x ?Mh(,? ? y • ? ? ? '? ? ? -- ?- . ? ? ?,? ? ? ? ? ?, ? I . ! ??? . , ?• ? 04--- 1 ? ?1 A ' 1 i t a ? i r ? ? ' ?t f ????4 ?"""? •:? ? TRUNK AREA WATERI?111IN 11ND TRUNK AREA SANITARY SEWER ?? LA'l'ERAL BENEF:IT FROM TRUNY. WATERMAIN ? 4 -7 6-7 194, x s 2004 RESIDEN'I'IAL BUII.DING PERNIIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 NewConsWclionReauiremenfs RemodeVReoairReauirements 3 regislered site surveys showirg sq. iL of b6 sq. ft. ot house; and all rooTed areas 2 copies of plan C??fSur?e Reid?Y'_ N x; (20% maximum lot coverage allowed) 1 set of Ener9y Calculetions for heated additlons ??"??s?, f^y t? s _ 'h. 2 capies of plan slwvdng 6eam d window sizes; pou2d found des5 Y !ea te, n, etc. 1 sne surve for addNOre & dedcs TW?? ` lsetofEne?gyCalculations Adddion-indicateilonsHesepGCSystem 3 copies of Tree Preservafion Plan rf bt plat[ed aRer 111193 Rim Joist Defeil Opfans selection sheet (Md?s witli 3 or less units Date ? L? Construction Cost D ano%=- Site Address ?T/_ /J Q UniUSte # Description of Work /,vao,-V 0`- NrPc,? ?'i? r Multi-Family Bldg _ Y? N i Fireplace(s) ? 0 _ 1 _ 2 Property Owner 4? f-.(m.? Telephone #(?1 O L% o (D Contractor -ti Address City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Tvlinnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category , Residential VentilaHon Category 1 Worksheet • New Energy Code Worksheet (J submission type) Submitted SubmiNed • Energy Envelope Calculations Submif[ed Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. Licensed Plumber Mechanical Contractor Sewer/Water Contractor Telephone #( Telephone #( Telephone #( ? I hereby apply for a Residential Building Pemut and aclrnowledge 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 State 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 appmved plan in the case of work which requires a review and approval of plans. •-?.-? -X 0l Qn? Appl? icant'sPnntedName ApplicanYsSignature OFFICE USE ONLY Sub Types ? Ot Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? OB 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. AR - Multi ? 03 01 of_ plex ? 09 07-plex -< 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt- SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower Level O 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous Work Types ? 31 New ? 35 In! Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building• ? 43 Reroof ? 46 Windows/Doors ? 34 RepleCement 'Demolition (Entlre Bldg) - Give PCA handout W applicant Valuation °"f V?-i Occupancy MCES System Census Code ? Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS _ Footings(new bldg) FinaVC.O. _ Footings(deck) g FinaUNo C.O. _ Footings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof Ice & Water Final Pool Ftgs _ Air/Gas Tests Final ? Framing _ Siding _ Stucco _ Stone _ Brick Fireplace _ R.I. _ Air Test _ Final _ Windows _ _ Insulation _ Retaining Wall Approved By: --------------------- - , Building Inspector ------------------------ ------ - -- --- Base Fee Surcharge Plan Review /0 O? n? l? MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total (, -5 a 3 ? 2004 RESIDENTIAL BUII..DING PERNIIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New CoreWcflon Reauiremems RemodeUReaair Renuiremenffi 3 registered site surveys shwring sq. R of lot, sq. ft oi house; and II rookd areas 2 wpies of plan (20% maximum Wt coverage allowed) 7 set of Energy Caknlations for heated additions 2 coples of plan showing bean & window sizes; poured found design, etc. 1 site survey for addilions 8 decks t set of Energy CakulaUons Addnion • indicate ff onaile septlc sysfem 3 copies of Tree Preserva6on Plan ff bt plalted after 711193 Rim Jast Deml 0ptiAns selection sheei (bldgs with 3 w less unils Date Construction Cost Site Address UniUSte # Descripdon oF Work 1?2 v J/ ?Uo Dc+a,? ea ?,? Multi-Family Bldg _ Y _YN Fireplace(s) K0 _ 1 _ 2 Property Owner ? g ? l$ B .,,- Telep6one #( GS7 )V SLI 01-149e Contractor O Address 1 oZ ' ? City F' 51k^e, State Zip Telephone #( 6? ?fV-,1,5y v C7 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Yvlinnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category , Residential Ventilatlon Category 1 Worksheet • New Energy Code Wwksheet (J submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with fee applies. , Licensed Plumber Mechanical Contractor Sewer/water Contractor _ Y _ N If so, 25% plan review #( #( I hereby apply for a Residential Building Pemut and aclmowledge 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 State 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 appro plan in the case of work which requires a review and appmval of plans. ApplicanYs Printed Name Applicant's Signature ' Iq SEWER GONNECTION CHARGES CITY OF EAGAN SEWER & WATER CONNECTION CHARGES - 1990 EXISTING PROPERTIES SAC $ 700.00 Previously Pd. Receipt # ACCOUNT DEPOSIT 15.00 SEWER PERMIT & SURCHARGE 15.50 TOTAL: $ 730.50 WATER CONNECTION CHARGES WATER CONNECTION $ 625.00 Previously Pd. Receipt # ACCOUNT DEPOSIT 15.00 WATER PERMIT & SURCHARGE 1550 WATER METER 90.00 TREATMENT PLANT FEE 252.00 PLBG. PERMIT & SURCHARGE 12.50 TOTAL : $1, O10 .470 TOTAL FOR SEWER & WATER HOOK-UP: $1,740.50 ?CO,C i - Icps 1,4Q .'i C. --•--------------------------------------------------------------------------------- F-I?•4D t'd. ?1040.;)0 OFFICE USE ONLY ? ?A? , Sew<r TAPS PRV R? ASSESMENTS .Q$ 520 cuY.'iv,E o'P (?iar.q ? _1J` A 6 PROPERTY OWNER FLORENCE OLSON TELEPHONE # 454-3687 ADDRESS 1250 CLIFF RD L O11 B 2 SECT. SECTION 34 PID # 10 03400 O11 02 DAKOTA COUNTY loll, ? ??ott) EWA`bh??aNOA?orv DIFEGTGP (672) 450-2611 PUBLIC HEALTH DEPARTMENT Fax (612) 450-2948 HUMAN SERVICES DIVISION 33 EAST WENTWORTH, WEST ST. PAUL, MINNESOTA 55118 flEP! Y Tp PUEIIC Health NuTng $ervmB Environmenlel Hnllh Servieea ? Emergmcy MeCinl Sen¢ea April 30, 1990 Mrs. Elorence Olson 1250 Cliff Road Eagan, Minnesota 55123 Dear Mrs. Olson: RE: Surface Discharge of Wastewater ? PuEbc Health NorLny SernCe BurnsvJle OPoCe (8121 475-8055 1101 WestCty RE 42 Bwnsnlie. MN 55331 C E R T I F I S D M A I-L RETURN RSCSIPT REQIISSTSD We investigated a complaint of illegal wastewater discharge from your property on April 18, 1990. Verifying the complaint, we obsetved that sewage is being discharged to the surface in the ravine behind your house, 1250 Cliff Road, Eagan. You are in violation of County Ordinance No. 113. (On-Site Sewage Treatment Systems) and Minnesota Pollution Control Agency (MPCA) Rule 7080 (Individual Sewage Treatment System Standards) by: 1. Discharging wastewater to the surface; and 2. Not properly operating and repai=ing or reconstructing your on-site sewage system to prevent malfunctions or failures which may pose risks to public health and safety. You are hereby ordered to comply with Ordinance No. 113 and MPCA Rule 7080 by completing the following in a timely manner: 1. Immediately cease your iaproper discfiarge of sewage to the surface by frequent pumping and/or reducing water usage. 2. Contract with a County-licensed ISTS (Individual Sewage Treatment System) pumper-cleaner within ten (10) working days to properly pump and clean your sewage system as required in order to schedule a licensed ISTS installer to evaluate your sewage system and determine the cause of the malfunction or failure. AN EQUAL OPPORTUNTY EMPLOYER 3. Contract with a County-licensed ISTS installer and - coordinate with the ISTS inspector to undertake the following within 60 working days: a. Evaluate your sewage system's malfunction or failure; b. Determine if your sewage system is conforming and repairable or if your system is non-conforming and must be reconstructed to meet applicable regulations; and 4. Perform all such repairs or reconstruction of tne sewage system as required by the ISTS inspector, or connect to a public sewer system if one is available in your area. I have enclosed a current directory of County-licensed ISTS installers and pumper-cleaners. Please contact Doug Reid, Buildinq Official, Eagan (612-454-8100), and our office when the sewage system is pumped and cleaned and is open for inspection to evaluate its operation and determine specific requirements to correct above conditions. Should you have any questions or require assistance, please contact me at telephone 450-2940 or Ron Spong at 450-2607. Sincerely, Berhane Worku Environmental Health Services Water Quality Management BW/sh, WQM:SDWW pc: Ron Spong, Environmental Health Supervisor, Wate= Quality Management Doug Reid, Building Inspector; Eagan Jay Stassen, Assistant Dakota County Attoxney Encl. aA Rcf- c F; l.e WAIVER OF HEARING NO. 00334 SPECIAL ASSESSMENT AUTHORIZATION I/We hereby request and authorize the City of Eagan, MN (Dakota Co.) to assess the following described property owned by me/us: Plat and Parcel #10-03400-011-02 for the benefit received from the following improvements: ITEM OIIANTITY RATE AMOUNT PROJECT NO. Lateral Benefit from Trunk Water Main 349.39 Lin.Ft. $ 14.18 $4,954.35 224A Water Trunk Area 2.02 Acres 1,450.00/Ac 2,929.00 224A Sanitary Sewer Trunk Area 2.02 Acres 1,435.00/Ac 2,898.00 88 Pt.II TOTAL $ 10.782.05 to be spread over 5 years at an annual interest rate of 88 against any remaining unpaid balances. The undersigned, for themselves, their heirs, executors, administrators, successors and assigns, hereby consent to the levy of these assessments, and further, hereby waive notice of any and all hearings necessary, and waive objections to any technical defects in any proceedings related to these assessments, and further waive the right to object to or appeal from these assessments made pursuant to this agreement. ? Dated: -) 9 '- F[? ?,,?'?.2? ? Florence H. Olson STATE 0 ? )SS COUNTY 0 On this /C % Jy day of 19,'?6) before me a Notary P,ublic within and for said County, personally' appeared rG oh? C:--i?Gc `-/V. IS;GS Dlt) to me personally known to be the person_ described in and who executed the foregoing instrument and acknowledged that ,S executed the saIme as yd E,? free act and deed. ---,/ 4"4 A- 14;,Jj 1 Eagan Public orks Department 14:51 OCT 22, 1996 ID: DRKOTFl COUNTY TEL MD: 4388517 16, ojqov - ol/- o ;2- ? •5798 PAGE: Sii Municipal Notice of WeU Permit Application Dakota Cwnty Ernironmentel Maaagemem Depafttnetrt Wata wd Land Managemcw Sediou 14955 GeEaxtie Avenue West Apple Valley, NIId 55124 Tel (612) 891-7011 Fax (612) 891-7031 DATE: October 22, 1996 TO: Taen ColbertlWayne Schwanz FROM: Wata and Land Management RE: WellPpmit #: 96-h110172 Muoicipafiry: Eagpn Fax #: (612) 6814612 WeI( Type: Seakd Envirwimcutal Spaciaust: Olson The Water and Laad Management Sectaon af ihe Dakota Coumy FnviranmwNal 1NanagemsR Depazhneat has receivad the followmg permit application for the weU described. If you requae Eudxr ieview of 1Le application or if you have any quesEions or concerns about it> mntatt the Environmtental Specialist listed a6ave or our office a2 (612) 891-7011. [f there is no response 6nm your office arithin 24 HOURS (exclu3ing weekends and hoiidays), we will assume that you have ao ob,{ections to the issuance of We permit. Please oote that pe:mit issuaacc is always coaditionod an thc pmmit applicaat's observana of and oompSance wiiL all aPPlieable state, countY, and mumcipal laws and codes. WeU Caotrac[or: Hardnann Well C.oanpazry Date applicadon received: October 22, 1996 Anbcipated Drilling Date: _! /_ Time: Anticipated Groutmg Dau: % Time: -'- _ Property Owncx: Duane Olson Well Owner: Duane Olson WELL LOCATTON: PLS Coordioates: 1/4, ae 1/4, nw 1I4, ne 1/4, Sac 34, Town 27, Range 23 Strcet address: 1250 Cliff Rd PINIViunber. 10-03400-011-02 WELL INFOM Diameoer: Casiog depth: Total depth: Static Waur L,evel: Aquifer: CONAAENTS: 4 I55 160 136 unoonsolidate3 ssdimeats R-97% DAKOTA GDUNTY I0-22-96 02:67PES P001 it47 CITY USE ONLY L BL RECEIPT #: susD. 16 - 0.W0 - o/l - O?- DATE: ?? -8?(O/ 1996 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612)681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit FIXTURES EACH Shower 3.00 x Water Closet 3.00 x Bath Tub 3.00 :c Lavatory 3.00 x Kftchen Sink 3.00 :c Laundry Tray 3.00 :c Hot Tub/Spa 3.00 :c Water Heater 3.00 :< Floor Drain 3.00 x Gas Piping Outlet ' minimum -1 3.00 x Rough Openings 1.50 :< Water Softener 5.00 x Private Disposal ' Dakota Cty. Iicense 65.00 (new and refurbished systems) U.G. Sprinkler ' home under const. 3.00 Alterations " to existing 20.00 Water Turn Around 20.00 STATE SURCHARGE TOTAL bQ TOTAL ?lo•? .50 ?'O ? SZJ SITE OWNI INST/ STREET ADDRESS- ??^?? ;???? ? ?= ?-?t • CITY: STATE: GLJ ZIP: PHONE #: 14 :51 OCT 22, 1996 ID: DAKOTR COI.INTY TEL N0: 43BB517 ? J?j'?C. ? ?cd 7 #5798 PRGE: Sil Municipal Notice of Well Permit Application Dakota Coumy Environmental Managemem Departmern Watcr and Laod Managemcnt Section 14955 Galmcie Ave,nue West Apple Valley, MN 55124 Tel (612) 891-7011 Fax(612) 891-7031 DATE: Odober 22, 1996 T0: Tan ColbertJWaync Schwanz FROM: Water and Land Management RE: Wdl Permit #: 96-h110772 MimiciPalitY: E3San Fax #: (612) 6814612 WellType: Sealed EnvironmaIIal 5pacialist: Olsoa Tbe Water and Land Management Sectim of the Dakata County Fnvironmental M2n3gement Deparhnent has received the followmg pen?rit applira6oa for fhe well desaibed. If you raqufre finther nwiew of the appGcation or if you Lave any questions or cmceros about it, contact the Enviromneotal Specialist listed above or our office at (612) 891-701 l. [f there is ao response from you: office wit6in 24 HOURS (excluding weekeads and ho&days), we wiIl assume ihat you liave no objec0ions W the issuance of tLe pcmvt. Please mote tliat pcimit issuana is always rnnditioocd am du pennit appGcart's observance of and compGance with all aPPlicable state, courty, and mumcipal laws and codes. Well Contractor: Harhrum Well Compaoy Date application received: Octo6er 22, 1996 AnlicipatedDrillutgDate: _l l Time: --- Anticipated Groutmg Date: f/ Time: Property Ownea: Duane OLson Well Qwner: Duane Olson WELL LOCATION: P1S Coordinates: 1/4, ffi I/4, nw 114, ne 1/4, Sec 34, Town 27, Range 23 Strat address: 1250 Cliff Rd PIN Number. 10-03400-011-02 WELL INFORMATION: Diameter: 4 Casing depth: 155 Total depa- 160 Static Water Level: 136 Aquifer: unconsolidated sediments CONgdENTS: 8-97% DAKOTA COUNTY 10-22-96 02:47PM POOI #47 For Office Use + Permit#: 5'S SO EAGANPermit Fee: 1 Ci Date Received: IZAZ / I e 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff: $(6-e) buildinginspections at citvofeagan.com L / 2018 RESIDENTIAL BUILDING PERMIT APPLICATION /07 Date: lei Site Address: /s c L/ /,Z Unit#: Name: ��iiq,'v G-fG�/V Phone: Resldentl `l i C wnefi- _"1_1. Address/City/Zip: /,,7 CG7r7- � r`-fo f ' //1 iNrya Applicant is: Owner Contractor Description of work: /Vett Typei.of Work Construction Cost: Multi-Family Building: (Yes /No_ —T Company: Pm',D E v5 T C' ' 'r4i ontact: r a L1-C ��;�il i Address: /a?7,1101/9t749/4 ('9•: S', City: -X,40ied,e' State:��// Zip: J✓J7� Phone: ���'—V ) j7/'mai 4 c41��c"4 f ccez- dry f ' .' License#: G/ off �lo Lead Certificate#: If the project is exempt from lead certification, please explain why: ND 'SAS i'Y,t/2,�3/•,✓6 */'A/7"' 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: Fire Suppression Contractor: Phone: MOTE:Plans ands®®"° ®' "are considered to he=ublic/nformat1r Portio re tr classified a - .=hc if a< •vrde r .. s that w u d = e. .•� .®�x h .drat a are de" cret You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at www.citvofeagan.comisubscribe. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. 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 acco iance1th the approved plan in the case of work which requires a review and approv plan pf� E" x '44t1l!' Ste— Applicants Printed Name Applicants Signature