2128 Cliffview DrCITY OF EAGAN 9666
3830 Pilot Knob Rosd, P O Box 21-199 Ea o MN 55121
Site Add9 ss
Lot
Parcel No. .
? Neme RANDY BROWER
? Address 2128 CLIFFVIEW DRIVE
City EAc'AN Phone 4 52-713
?
Name SAME
0 U Address
8 City Phone
? W Name
?? Address
? W City Phone
I hereby acknowledge thot
the inlormntion is corre
State of Minnesota $tat?t
ond
oll
-.
' -
? ........reI-r
-
Remodel toning
Repeir ? Type of Const. V
Enlarge ? No. Stories
Move ? Length 2 0
Demolish ? Depth 24
Grade ? Sq. Ft.
Aporevals Fees
Assessment
Woter & Sew.
Police
Fire
Enp.
Plonner
Counci I
eid9. off. 11 6
APC
Var. Date
Permit J O . 7 V
Surcharpe 1.50
Plon check
SAC
Water Conn.
Water Meter
Road Unit
Parks
Total 40.00
K on !he expross condition Ihat
of Minnesota Statutes ond City of Eopan Ordinonces.
'Z U. Ql L-
Sfpnoture of Pern+ittee ?
A Buflding Permit is iuued
oll work shoR be done, iry/ a
1
Buildinp Officlol
Block - j sec/Sub.
. 98 .
PHONE: 454-8100
BUILDING PERMIT Receipt # _ ?
Permit No. PKmk Holder Data
Plumbing
H. V A.C.
Eleetric
Softener
Inapection Data Insp. Other
Footinga
Foundation
Framing
Rough Pibg.
Rough HVAC
Insu Istion
Final Plbg.
Final HVAC
Final
cwvocc.
3 "
Oale4
Water Describe Location:
VYell
Sewer
Pr. Disp.
?
CITY OF EAGAN
3796 Pilot Knob Rood Eagan, MN 55122 N2 6709
PHONE: 4548100
BUILDING PERMIT Receipt #
To wmeW foe Est. Value Dote , 19
Site Address Ereci ? Otcupancy ?
Lot Block Sec/Sub. Alter ? Zoning
Parcel # Repalr ? Fire Zone
l
E of Const
T
arge ?
n ype
.
W. Name - Move p # Stories
z
Address
Demolish ?
Front ft.
Ci Phone -- Grade Q Depth ft.
?
o Norne Approvola Fees
-
?
?? Address
F r,.., ati.,.,e
Nome _
Address
I hereby ocknowiedge thot I hme read this opplication and state that
the information is correct ond agree to tomply with oll applicable
Stote of Minnesota Statutes and City of Eagan Ordinonces.
Assessment ?.
Water & Sew.
Polica
Fire
Eng.
Plonner
Council
Bidg. Off. _
APC
Permit -?
Surcharge
Plon check
SAC
Water Conn. -
Woter Meter -
Rood UniL `
Total , -
Signature of Permittee I
A Building Permit is issued to: '? - on the express condition that
cll work shall be done in accordance with o11 applicoble State of Minnesota Statutes and City of Eagon Ordinances.
Building Official
PwwM # Dah Inaed P?ewIMN
Plumbing :2 (?' S
? '7- - 9- 0. (k
Mechanicol 2S ;3 -7
7qs S '7-I 3- 5- sunfl"s g
INSPECTIONS DATE INSP• RoupMln Finol
Footings Date Inap. Dote Irup.
Foundotion Plumbing j
Frame ins. - MecFanical
Final /
?
Remarks:
Raceipt MECHANICAL PERMIT
CITY OF EAGAN
Fi/l in numbered spaces
Type or Print /egib/y
1. Date -- ? 2. Installation Cost
3. Job Address Lot ' Bik.
4. Owner -, LM`ikN11jL.
Permit No.
Fee
S/C
Tot. °
Tract , ' "'L
5. Contractor Phone
6. Address ? 7 iJ_c -c
7. City ?- ' State 1' • Zip
8. Building Type: Residential 13
9. Work Description: New M
Commercial ? Institutional ?
Add O Aiter O Repair ?
10. Describe -- ' f Fuel Type 7. _t j.r,- +
1 11•
No, Eauipment 9TU • M. Ea.
Forced Air No. Equipment CFM
Ai
H
dli
Mfg. an
ng:
r
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 allordina?)7s-and codesgovefning this type of work.
5igned :
for
Rough ? Final
,.' Inspections: Date Insp. Date Insp.
- This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Raceipt PLUMBING PERMIT Permit No.
CITY OF EAGAN Fee
Fr!l in numbered spaces S/C
Type or Print /egib/y Tot
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract
4. Owner
5. Contractor Phone .
6. Address
7. City State
8. Building Type: Residential ?
9. Work Description: New 0
10. Describe
11.
Zip
Commercial ? Institutional ?
Add ? Alter O Repair ?
No. Fixtures
Water Closet No. Fixtures
Cess
ool/Drainfield
Bath tubs p
Se
tic Tank
Lavatory p
Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
I comply with all ordinances and codes governing this type of work.
Signed ' for
Rough Final
lnspections: Date Insp. Date Insp.
. This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
.' ?
- - ------------ - _ ._?_ _
-_ , ,. ., • ?,::...
CASH RECEIPT ?
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
RECEIVED
AMOUNT $ I
& DOLLARS
?oo
E]GASH ? GHECK
FOR
FUND CODE AMOUNT
Thank You
??.-- B Y
wnice-Peve?: coov
Yellow-Posting Copy
Pink-File Copy
C?rr#ifiratt af (Orruvanry
Citp of eagan
Dr.pttrimrnt nf Nuilbing ltto.ppr#imt
Tbi.r Certi f icule i.uued pursuant to the requrrementd o f Sectivn 306 of the Uni form Bsriltling
Code ccrtifying that at tbe timc of i.csuarut thir strrrctlire wat in compliance u7th tbc yurious
ordirtantet of 1he City rcgulating build»tg con.ttructron or use. Far the f o!lournK:
u,e cinarv.am Si ngl P Fami ly I)uvgll_i11g Bidg. Permit Nu. 6709
Ot?Pwx9 TYPc ----?.a---TyP Coutruction.V_ Flre Zonn NA _ Zoaing Disinct RI
Urnerof&Ad'and 7AP}1R1AT Nnmc+c_ 7nnAaa-ss lttien r
gu8ding qddras 2128 Cl iffview T?`_ L.?w;,Y Tnt 5. Rl ot-k 3. .edar -C]jff
5_
Bu1{dingOtBdal ?;; ? DLte:_A?s?-1?#,,_1981
¦O!T IM A -ICUWY I4C[
PRlCE:
Site
Lot.
? Name _
m Address
c City ?
?
? Name _
3 Address
O CitY ?
PERMIT #
PLUMBING PERMIT RECEIPT #
CITY OF EAGAN ?
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ?:??? ?_?.S7, Cc /.3f2
PHONE: 454-8100
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPUES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S!C IF PERMIT PRICE GOES
BIDG. TYPE WORK DESCRIPTION
Res. New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $100 $
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50 ,
Water Neater - $1.50
Whiripool - $3.00
Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn
k-goftener - $5.00
Well - $10.00
Private Disp. - $10.60
Rough Openings - $1.50
FEE:
II STATE S/C:
FOR: CITY OF EAGAN GRAND TOTAL: X??-?
.,. r r VF EAGAN Remerks
Addition CEDAR CLIFF 2ND ADDN. Lot S Blk 3 Parcel
owne? ?t N41(l t I ? 'r?}? ?roufer streec 2128 Cliffview Drive State Eagan, MN 55122
lmprovement Date Amount Annuai Years Payment Receipt Date
STREETSURF. 1983 1776.56 355.31 5 1776.56 C007772 8-2-82
STREET RESTOR.
GRADING 3 1983 522.84 104.57 S 522.84 C007839 9-13-82 ?
SAN SEW TRUNK 1973 4 94 $ $ 47•68 aQ10499 8-2 "'81 i
*SEWERIATERAL 1983 2182.58 436.52 5 2182.58 C007839 9-13-82 '
I
WATERMAIN I
* WATER LATERAL 1983 S i
WATER AREA 7.2 AOZO 99 2 1
*Services 1983 5 i
STORMSEW TRK Sag, 98 452.03 914 $ 3'()1. 3 Aoio g9
STORM SEW LAT 1982 756.57 5. . !0-1-61
& GUTTER
SIDEWAIK '
STREET LIGHT
Road Unit 185.00 25058 6-9-81
' WATER CONN. 335.00 25058 6- -81
BUILDING PER. 6709
SAC
PAR K
I
SEDGWICK HEATING & AIR CONDITIONING CO. TEST HEANG RECORD JOB NO.7,
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000
ADDRESS ? ??.??i ? I? ? r(• ? r
cirr
OCCUPANT
SOLD BY < G'--' A-1 IOL MAKE
OWNER
INSTALLED BY lL ?
MODEL Ur t, v f4 T a i i P ci . ,
SERIAL NO. INPUT
THERMOSTAT iffd-?
VALVE
LIMIT
LIMIT SETTING
FAN SETTING f
'
PILOT TYPE J
IGNITION MODEL ?n #X
PILOT TIMING
PRESSURE ?'? I? •? ? PERCENT CO2
INPUT CFH PERCENT OZ 7`L
STACK TEMP. .2!L0 c? PERCENT CO
FORM 235 (REV. 11/89)
VENT SIZE y
TYPE OF LINER ,//-(/w,
LINER SIZE 6
FILTERS: SIZE/ l'-;o NUMBER ?
WIRING
TEST TAG S
LIGHTING INST S
DATE TESTED ?3 G 6
COMPANY TESTING 'e- 04&14
NAME OF TESTER
FORM,I TION: WHITE COPY - JOB FILE YELLOW COPV - CITV
-7113 LS, j33f c?C?? .2'7, 5-0
This request void v
18 months from 734p
Date of this Request 6-29_81 Fire Ho. T434S4 ?
I, as 11 Licensed Electrical Contractor 0 Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. 2128 cliffview City Ea;an
Section Township
Range County aknta
Which is occupied by r7__,1_ra?Tj?
p? eS
(Name of Occupant)
Is a roughin inspection required on this job? No ? Yes 9 Ready Now ? Will Call ?
Power Supplier Dakota Ei ectric Address
Electrical Contractor ' Contractor's License No. ?.4.?7g
(Com ny Name)
Mailing Address 4120 83rd Ave. No. Mpls, Minn. 55443
(Electrical Cont?actor or Owner Making This Installatlon) ,
Authorized Signature RPi .h R usl; Phone No. )-66-8600
(Electrlcal Contractor or Owner Making This Installatlon) r? {,.•, • •
STATE BOARD COpY This inspection request will nat be accepted by the
State Board unless proper inspection fee is endosed.
Minnesota State Boa?d of Electricity
Griggs Midway Bldg. - Room N191 EB-00001-02
1821 Universiry Ave.. 5t. Paul, Minn. 55104 - PFqne 297_2111 ZS 73(,0
REQUEST FOR ELECTRICAL INSPECTIUN
CHECK BELOW WORK COVERED BY THIS REQUEST T 4 3 4 8 4
Type ot Building New Add. Rep. Check Appliances Wired For Check Equipme nt Wired For
Home ? ? Range ? Temporary Wiring ?
Duplex ? ? ? Water Heater ? Lighting Fixtures ?
Apt. $Idg. ? O D Dryer ? Electric Heating ?
Commercial Bldg. ? ? ? Fumace ? Silo Unloader ?
Industrial Bldg. ? ? ? Air Conditionet ? Bulk Milk Tank ?
Farm ? ? ? List List
Other ? ? O $ehers? Rehers?
COMPUTE INSPECTION FEE BELOW
Service Entrance Size: # Fee Feeders&Subfeeders: # Fee Circuita: # Fee
0 to 100 Am s. 0 to 30 Am res 0 to 30 Am eres , 0
101 to 200 Am s. 31 to 100 Am res 31 to 100 Am eres
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Tra ers
S'
Rem
a: • Remote Control Circ.
Special Pariial oi other fee
Minimum fee 55.00
TOTAL FEE P OU
I, the Electrical
(Final)
This request void
18 months from
tlie aboVEITs-pection has beeZnwa jD /
?.Q Date
T"
na1q- /7-k/
WATER SERVICE PERMIT
PERMIT NO.:
DATE:
- No. of Units: '
•••••. COIIr1@C'flOfl a1 r
0fg@; -r..
/?CCOUfIt DCpOSiY:
No.: Permit Fee: _ i i•
to oompip wieh the Ckr of Eayon Surcharge:
By
Date of Insp.:
Misc. Choroes; ' f _ - • ,
Totol:
Dote Pnid:
I nsp.:
CITY pF E ?
AGAN SEWER SERVICE PERMIT i
379b Wlof Knob Rood PERMIT NO.:
Ea9en. MN 55122 DATE:
Zoning:
Owner• ? ?C}:r:c„ No. of Units: `
Address:
Site Addi
Plumber:
1 egres te eomPyr wil6 60 Ciryr of Eege¦ Connectton Charne:
Ordinaness. Account Deppslt:
Permif Fee: ,
8y Surchorpe: Dote of Insp.: Misc. Char'Des:
Totcl:
I nsp.: Qote Pald:
?
CITY OF EAGAN
3795 Vilot Knob Reed Eagan, MN 55122
PHONE: 454-8100
BUILDING PERMIT APPLICATION
To be med for SF DWQr Est. Value 42s000 Dote 7Une 9 , 19_$1
Site Address 2128 Clif fvi W 1_1i`iY t
E O
re<
ft] ccupancy-]Z$_
Lot _ 5 Blxk 3 Sec/Sub. CedaT Cliff 2 qlter ? Zoning _ Rl
Parcel # 10 16601 050 03 2epair ? Fire Zone NA
V
Enlarge ? Type of Const.
c Nume 7BCklII19II A xIDPB, IT1P Move ? #$tories
3 Address 7760 Mit ehell Rd Demolish ? Front 36 _ ft.
0
Cit F'A
2i1 P"'TT`io
Phone 937-9520
Grode ?
Depth v+ ft.
w Name (ky ApProrals Fees
o PFS9F
?' Address
f nw,
Name _
Address
I hereby acknowledge thut I have read this opplication ond state that
the information is correct and ogree to comply with all applica6le
State of Minnesota Statutes and City of Eagan Ordinances.
$ignoture of Permittee
A Bullding Permit Is issued to: zFk?
all work shall be done in uccordance with ell
Building Official
Stote of
Receipt #
on the express condition that
Statutes and City ot Eagan Ordirwnces.
.
???(?'\ CITY OF Er`:CA.N Include 2 sets of plans,
1 site p1an w/elevations &
BUILDING PERMIT APPLICATION 1 set of energy calculations.
Zb Be Used For C,Y,?. ',I ? Valu tion Date
OFFICE USE OAII,Y
Site Pc'dress:
Lot ;S siocx ? se?.Is °. ? Erect occupancy
' Alter 2oning /
Parcel
Repair Fire Zone
Oaner: "arge _ TYPe of Const.
Nbve # Stories
Pddress Delrolish Front 36 ft.
Grade Depth l??/ ft.
City/Zi -?
Phane #
Contsactor:
Address: /
?
City/Zip Code:
Phone #
Arch./fng.:
Pddress:
City/Zip Cocle:
Phone T:
MEMM?
Assessment A
Water & Sew.
Police
Fire
Eng.
Planner _
Council _
Bldg. Off. -
APC
N° 6709
Gertnit ZZn ;10
Surcharge _23 -00
-
Plan check (,tQ.-?15
SAC 5?1,5 00 -
Water Conn. 335..Q?
Woter Meter 60 w00
Road Unit _- I$5r1
Q
Totol z306?5
APPROUALS FEES
Assessments ! '/7e/ Pernut /;?l a-,
Water/Sewer ,t
?
Surcharge -21
Police Plan Check /n -'.
Fire SAC Sa5 ?'
EnJ •
Water Conn. 3 3s ?"
-
plannpx Water Meter O d:0.
COllT1C11 ROdd ULll..t. / * 3-
Bldg. Off.
APC
TOi'AL /30CP ,Z 6
'_''?-
• CAIZ.VIN H. HEDLUND 9609 r,irare Avenue sautn ?
Bloominqton,Minnesoto 55431
?
Land Surveyor Clvfl Enpln??r Phone :888-2080 i
eer?dte '
f«
JOB N0.
SURVEY FOR: Zachman Homes
DESGRiBEO A5; Lot 5, Block 3, CEDAR CLIFF SECOND ADDITION, City of Eagan,
Dakota County, Minnesota and reserving easements of record.
T
404.0
? ? ?_'?.?i? ?.?•
?
? M
Z ?
lo'?
S+o ke
A
?' _'- --_ - - - -,
I ?
I '
?
? I
?
?? oz 6 y?. y ?N
?- ?
9035
6 ? -zg ; I
SPLIT F'oYE2 GAR ?j`
?WoopHuR?T? `? ?-4^%?s
_.?
uz.?o qot,?, ? ??
L? ? _ ? v¢\,? ? I
_ -J
6 7.6 9 ?z.sz
CLIFFVIEW
DRiVE A
Top of blo?k 903.3
Basement f toor 900. /
Drai nage arrows. -P?
ProPosed elev. C>
Exis-F;ng elev. _
Denotes lot iron o
--- $9?
tERTIFIGATE OF SUovcv
I hereby certify that on S-7 ,1 /8/ = surveyed the property described above and ihaf
the above plot is a correct representofion of soid survey.
(?i-,J).:_
Calvin H. Hedlund. Minn. Rep. No. 5942 kz-
CITYOFEAGAN M 9666
3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55127
PHONE: 454-8100 r
BUILD1NCa PERMIT Receipt
Te M wad 4er GARAGE Est. Volue 2,800 Date NO VEMSER 6 iy
88-1
,
-
SlteAddress 2128 CLIFFVIEW DRIVE Erect E1 ocwpancy R-3
Lot 5 elock 3 S+c/Sub. CEDAR CLIFF 2ND Remodel ? Zoning R-1
Parcel No. Repair ? Type of Conat. V
Enlerge ? No. Stories
W Name RANDY BROWER nnove ? Length 20
z qddrftt 2128 CLIFFVIEW DRIVE Demolish ? oepth2 ¢_
City EAGAN phone 452-7137 Grade ? Sq.Ft.
? N SAME Approvek Feas
iO ame
?? Address
f City
?W Name
Address
W.Zu Ciiy
I hereby ackrwwledge thot
fhe inlormotion is corre
Stote of Minnewta Sraru?
Sipnoturc of Pertnittee 7
A Buildfng Permie Is issued
aIi work sholl be doM '
Buildirp Officlal
Axxssment Permit 38_ SO
Woter &$ew. Surcharpe I - S n
Polica Plon check
Fira SAC
Erq. Water Conn.
Planner Water Meter
Council Rood Unit
BIdg.Off. 11 /h/$ Parks
APC Total 40 _ 00
Var. Date
on tha express conditlon tho+
Min'xwfo Smtutes ond City of Eapon Ordinonces.
I ? •
?? p,I,L CnNTRACTOEB MUST BE LICENSED WITH THE CITY OF EAGAN
6? INCLUDE Q SETS OF PLANS,
' Q CERTIFICATES OF SURVEY
Q SET OF ENERGY CALCULATIONS
'7 \C" ? ` ` lLi ? il-(
To Be Qsed For: G) A 0,A C-,? Valuation: A, CL; Date:
Site Address: (?1W C?iy-?f = ?
Lot: ? B1ock:?Sect/Sub:
d?. c
Parcel #:
Owner.
Address:
City/Zip Code:
Phone
Contractor: Sp,
Address:
City/Zip Code:
Phone #:
Arch./Eng:_
Address:
Phane
Phone
City/Zip Code:
Phnnalk •
this upDlicotion and store that
t?y with oll applicable
o an Ordirances. /,
Erect_ ? Occupancy:
Remodel: Zoning:
Repair: Type Of Const:
Enlarge: # Stories:
Mave: Length:
Demolish: Depth:
Grade: Sq. Ft.:
2-3
(•I
2.0
Z4
i APPROVALS
Assessments:
Water/Sewer:
Police:
Fire:
Engr.:
Planner:
Council:
Bldg. Off.:
APC:
Variance:
0
Permit: 38.-
Surcharge: ?. ?
Plan Rev.:
SAC:
Water Conn:
Water Meter
Road Unit:
Parks:
? 4 6, oo
2128 CLYFFV1EW TAYW 9 65iaa N ?-o-r= 5 cEuAp? c?FF (esaJ
?IoCK-3 aRd Addx.+soa , 452 --1137
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2006 RESIDENTIAL MECHANICAL rExNnT nrrr,icaTioN
? City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Pleace complete for: single family dwellings & towmhomes/condos when permits are requ'ved for each unit
Date j / ?..k / (J (p
Site Address /lki)/ a? Ah a Unit #
Property Owner Telephone
SEDGWICKHEATINGBAIRCONDRIO'ra:?IGILC
Contractor
Street Address Minneapolis, MN 55420 City
State Zip Telephone #
du
s
1041d Ex
ir
: 2 [? ? QpR 0 6 70116
:
on p
es
The Applicant is _ Owner ? Contractor _ Other
Add-on or alteration to existing drong uuit? l???
v $ 30.00
fumace r ? Replacement New
=Addit
_ air exchanger
airconditioner
heat pump
other
State Surcharge $ .50
Total
I hereby apply for a Residential Mechanical Permit and acknowledge that the information is comple[e and accurate; tha[ [he work will
be in confortnance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a
permi[, but only an applica[ion 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. V .
SEDGWICK HEATING 8 AIR CoNnlTim,,U6 i i r / U// ApplicanYs PrinBM'pgayqenft,yorth Ave. Applicant's Signature ?•iYnG?
Minneapolis, MN 55420
(952) 881-9000
Use BLUE or BLACK Ink
,_
For Office Use I
City of Eaall ::::e. -
/LI: //‘ 7 C
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651)675-5675
Fax: (651)675-5694 Staff:
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Or ' Site Address: ( /i ,�lef
7 w ®/ Unit#:
j Name: �i eKJ '/ /2Gd` 4- !/%,f d Phone� ?J( � �� ^ - 1;6
Resident// ' 1 � 4 5:57 g�(rc c/,&,1i3f.
Owner. Address/City/Zip: �' ((
l ;
.i Applicant is: Owner )(Contractor
Description of work: Q lCka-,....cf&4:5-e4_ % qType of Work � G'�iJ �o� l
Construction Cost100
Multi-Family Building: (Yes /No)C)
ten�e6 / 'des �C � �. /
' Company: (�' Contact:� l
Contractor i._I
! Address:/ ( f' �'�' </ �(�t'( fr37 City: # Q
StateZip;�3 S Phon'/tX 5'3'7 mail: S�-n c-F �' &ice r le( lj/•
Q// 07--//63.J oLicense# �C 6w " j` Lead Certificate#:
1 If the project is exempt from lead certification, please explain why:
i - 0C6 i
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of agan issued a permit for a similar plan based on a master plan?
Yes No If yes, date and address . aster plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: • _ e:
£ i
Fire Suppression 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
_ __, .e .,.,. conclude that they are trade secrets. .. . ,. ...�__ _ _m,, ...
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 if plans.
Exterior work authorized by a building permit issued in accordance with the Minneso/ St- e B !ding o• •e completed within 180
days of ermit issuance. y jj
. ( f i
x Q� i / 77
plicant s Printed Name . •p ican *Sig 'ure
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