1748 Hickory Hill
Use BLUE or BLACK Ink
T..„..
I For Office Use
City of Ea Permit#: 001
I I
I Permit Fee: < 1
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: O Site Address: / 7 ~~f/c i~ ~t L~~ 1
Tenant: cw&,# -S 7 ~ Fc'J Suite M
RESIDENT / OWNER Name: 4 ~ 7':~l Phone:
Address / City / Zip: 7 /z f
Applicant is: Owner Contractor
TYPE OF WORK Description of work:, t7~ /~c'c c~ s~.r1y
Construction Cost: 5~ c~. 4y V Multi-Family Building: (Yes / No )
CONTRACTOR Name: /,c_ License
Address: V City:
State: Aj Zip: 5S%Z S Phone: Y72 7
~ /~i Al Email: ;775-7 0j";,e7 n ~vrr~ ES Cy.-n
Contact: -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:
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 pl P~l
Applicant's Printed Name Applicant's Signature
Page 1 of 3
CITY OF EAGAN Remarks
Addition Wood.gate 2nd Lot 10 Rik 7 Parcel = p1 100 07
Owner l ' Street 1748 Hickoiy Hill State_ £''ag'?,MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. ?,33 1974 5.11 1.02 Paid
STREET RESTdR. ? 197 1 03 .7 3 .92 3 P31d
GRADING
SAN SEW TRUNK 197 99• 2 6.63 15 az
-x- SEWER LATERAL " 97 3068.71 .
WATERMAIN
# WATER LATERAL 1976 3
# WATER AREA 197
#
• STORM 5EW TRK 197
• STORM SEW LAT 197
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 1 0.00 7
BUILOING PER.
SAC 400.00 ?
PARK
C1TY OF EAGAN 10 173830 Pilot Knob Road. P.O. Box 21•198, Eagan, MN 55121 ?
PHONE: 454-8100
BUILDING rERMIT RKeia #
-r_ ?_ ----A A-_ i.ii Ct: e- v_1.._ •'1 /ll(,i n_._ ;t$Y „ to '-'j
Stte Addrop 1
Lot 1 I ' Black
Peresl No.
Neme
Addross
,? Neme
?? Address
Citv Phone'
I
I I
I heroby ocknowledys thot I hnw reod this application ond state thot
tM intormotion ia correct and ag?es fo comply with all applicable
Stah of Minnewro Stotutu and City of Eoqan Ordinonu:.
Siqnotun of Pam+ittN
A Buildiny Permff Is issued fo•
oll work sFwll be daw in atcordonCt with oll oppliooble Stoq of Mh
Suildirq Oifidol
Erect k:J Occupancy
Remodel ? Zoning
Rspair ? Type of Const.
Enlarge ? No. Stories
Move ? Length
Oemolish ? Depth
Grade ? Sq. Ft.
Install ?
Aooeo rals Eoos
Assessment
Woter & Sew.
Poliu
Fin
En0•
Ploemsr
Cauncll
Bldg. ott.
APC
Var. Date
PQrmit 4' l J • \I
SurtYwrge •5:
Plan Review
SAC
R
WOter Conn.
Water Meter
Rood Unit
Parkt
Total
on tM expreas candition ihot
y of Eoqan Ordinonus.
PKmft No. Pwmk Holdw Dob Tele hone s
Plumbitq
H.VA.C.
Ebehie
8oftefor
Irqpoetian Dats Insp. Othqr
Footfngc ?
Foundation
Freminp
Roofing
Rouph Pibp.
Rou9h HVAC
Inwlation
Final Plbp.
Finsl HVAC
Final
CMt/Oec.
Waar acrib+ Location:
NNp
Sewar
P?. D4p.
VIL"JIGC-0c EAGAN WATER SERVICE PERMIT
3795 Pilot Kno6 Rood PERM[T NO.: _ 1684
Eagon, MN 55122 DATE: _
Zoning: _PUD No. of Units:
Owner:
Address
Site Adc
Plumber: Thompson Pliunbing CA.
Meter Nfi' 45;? '7 7 Connection Chazge:
Size: ? ? Account Deposit:
Reader No.: ?.? mR! // Permit Fee: 1a_ 00 . _
1 ogroa ro eom?p?ly? ith tha Villoga ol Eogan Surcharge: _ 50 t?l
O
di
r
noncas. Misc Charges:
? Total:
BY ?GCtAdaTLry ?? Date Paid:
Date o£ Insp.: Insp,:
VILLAOk-vF EAGAN SEWEK 5ERV1% PERMIT
:
PERMIT NO
3795 Pilot Knob Rood .
_
5
2 DAT'E:
Eogan, MN
51
2
7.oning: pnD No. of Units:
nwner; New HOrizon Homes Woodyate II _
Address:
kor
Add
9i
, :°• y rr' ] 1 or Natzmt:JbAne
reas:
te
.
Plumber: mhmmp on l tunb1t14 CO -
400.OO?pd
tion Charge:
C
f E
ll
agan
onnec
oge o
i agree ro eompFy with the Vi
??ma? Accuunt Deposit
10 • 00
? ?
Permit Fee: .
• 50 ?
Surcharge:
Chaz
es:
Mi
gy_ g
sc
l
T
t
Jate of Insp.: :
o
a
ns Date Paid:
p.:
CITY of EAGAN N? 3506
BUILDING PERMIT
oWO.: .....?...?-'.'?.+.-.?/..?..?.,?. '.° .................
Addzea (Prasea!) ........a.?.:?:L!:-.'.-
Hulldar ................................................................................................
Addrau .......................................... .........................°------.......
DESCAIPTION
3795 Piloi Kaob Aoad
Eagan, MinnesoYa 55122
459-8100
Ddo C.:... 7
SSOSies To Be Ussd Fos Fsoaf Deplh Relgh! Eil. Coe! Pormi! F?e Remnrks
aS/•SO ???1? ,?f/C.?6r ? A'i I?
LOCATION / b'a-/ Straet, Road or othas Deeeription o! Loeafion I Lo! Slock Addifion or Trac!
? ?.
Thia parmii doas not auffiorisa !fie use of slzeele, roads, alleys or sidewalks nar does it give the owner or 6is agan!
the righ! !o esaete anp ailualion whieh is a nuisance os whieh psasents a hasard !o the health, safelq, eonvenisnee end
general wallsrs to enpone in the communily.
THIS PERMIT MUST HE KEPT ON THE PREMISE WHILE THE WORA IS IN PROGAE88,
T6is 8 !o eertiip, that. ??"..^.?...1?'.`..^.:`.??r.--..?{'..^..:::`.°.......has petmissioa !o erac! a.'?:'?-." '.?..?.."?.J.?..... "-' ....... ..........."'-'._npoa
the above described premise subjecf to the pxovisions of all applicable Ordinances fos the Ciiy of Ea "an ??
'? / , ?
-"' ............ ....""'- ..--"'-............. .""""......._ Per ?-?"t ? `a`'?._-.-,'
3? ? "...........___........"_"'.......""/_:?:..?4.."_."' ................"_'_"'...........'_'_.
Maybf? Buildinp Inapaefor
4
t
CITY OF EAGAN No 101 7 5
3830 Pi1M Kno6 Road, P.O. Box 27-199, EapaM ANN 55121
- '
BUILDING PERMIT PHONE:4548100 eece+ot -7?
Tn 6..re h. D`''CK Esr.volue $ 7 0 0 p,te may 3 1q85
gift pddnm 1748 HICKORY HILL
La 19_ eixk -L a••YSub. WOODGATE 2ND
Parca! No.
W Name PETER RINEHART
? pdd,en Sl1ME
C'rtv Pnone 454-8701
? Name SAME
euidr.a
City
Name
City
Phone
1 Mrcby atkrowladpa tMt I Mva read this epplication ond stota thaf
ths inlormotion it corcecf and ogree ro complY wifh cll cppliwWe
Sturo of Minnssoto Stotutes ond Gry of Eapen Ordiranres.
Slgpwturs of PermiMae
Bee[ ? O=DencY
Remodal ? Zoning
Repeir ? Type of Const.
Enkrge ? No. Stwies
Move ? Length
Demoliah ? Depth
Grede ? Sq. Ft.
Im<all o
Ayyrevah Fep
Assesvnenf
Woter E $ew.
Polks
firo
Eno.
Pianner
Couneil
ewg. Otf. 4/ 3 0/ R S
APC
Var. Date
Pe??t --?13 . V V
5u,d,,,y, .50
Plan Review
SAC
Woter Conn.
Wotar Maror
Rood Unit
Perkf
Totel ?
A 8uildiny Parmit is issutd fo: PETER RINEIiART m dw e?? ?? that
dl work sholl 6e doro in aeowdance with oll ! imble Sta?a ard Clty of Eapan Ordironcaa.
BWidinp OfHcid _
?. mmnnsma am'e wam m uacmciry
, Griggs Midway Bldg. - Room N791 C EB-00001-02
1821 Universiq Ave., St. Paul, Minn. 55104 - pFrone 297:2111
BEQUEST FOR ELECTRICAL INSPECTION' '
$ 66555
CHECK?ELOW WORK COVERED BY TH[S REQUEST
Type ot Building New Add. Rep. Ch¢ek Appliances Wired For Check Equipment W4ed For
Home ? ? ? Range ? Temporary Wving ?
Duplex ? ? ? Wa[ec Heater ? Lighting Fixtures ?
Apt. Bldg. ? ? 1:1 Dryer ? Electric Heating 0
Commercial Bldg. ? ? ? Fumace ? Silo Unloader ?
Industrial Bldg. ? ? ? Av Conditioner ? Bulk Milk Tank ?
Farm ? ? ? List List
Other ? ? ? Hehels? p
Herer$?
COMPUTE INSPECTION FEE BELOW
Semice Entrance Size: a Fee Feeders&Subfcedecs: # Fee Cixcuits: # Fee
0 to 100 Am s. 0[0 30 Am xes 0 to 30 Am eres
101 to 200 Amps. 31 to 100 Amperes 31 to 100 Am ces
Above 200 Amps. Above 100 Amps. Above 100 Am s.
Transformeis RemoteContiolCvc. Partialorotherfee
Si ns 1 1 Special lnspection Minimum fee $S .cC}
Remarks ?
TOTALFEE
I, the Electric3? lnspecto?, hereby certify that the above inspection has been made. ?, a°
(Final) G 1Gi5 , (4?xu,
This raquest void
18 months ftom
This request void X/C?, 7 ?
18 months from ? / L?? • ? a ? ?
Date of this Request -?-JF0 Fire No. ? S 66"5?
1, as ? Licensed Electrical Contractor ? Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. / J/ (n t0a&-f"/ `/ YC k City-F-6--CAV
Section Township Range County Uf1Ko'r4
Which is occupied by uQ ` ?k"Pr1'Cev 1`L--
(Name of Occ
Is a roughin inspection required on this job? No ? Yes O
Power Supplier Address _
Electrical Contractor?6u)?r?r Y?Y?Y
JCompan-y e)
Mailing Address 17??4 LLC?LlLt?(f ?,,?e l?
Authorized
or
Ready NowK Will Call ?
Contractor's License No. i
??n en ' d
Phone No.
?rletir 1 cantuccar or uwner maKing rnls Ins[allatlon)
C(? n?? n? ?D ?Op? This impectian request will not be aecepted by the
tJ L=3 BState 8oard unless proper inspeetion he is enelosed.
-7 GJ,5?7-"
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
FERMIT NO.: 640
The City of Eagan hereby grants to Geo. 3edgwick Heatinq & A/C Co.
of 1001 Xenia Ave. So.
a _ HEATING T Permi.t for: (Owner) ed. _?_ maaime_ ., ___
at, 1743_s174, Hickory Hill I pursuant to application dated I
?i?a
Fee Paid: $40.00 dated this 28th day of gehn,rz:y
1.00 s/c
Building Inspector
M?c;lajiical Psrmits:
blG `1'otal; _ I
I
Loco 7-
crrr oF Earrnra
3795 Pilot Knob Road
Eagan, Minnesota 55122
PERPiIIT NO.: 543
a Pluml>ing Permit for: (Owner) New ttorizon Homes Woodgate II
23 Permits
at SEE ATTACFED LISTING pU.rsuant to aPFlicaticn dat°d 1/21/75
Fee Pcid: $460.00
The City of Ea.gan hereby grants to Tkompson Plumbiny _
o; 12201 Minnetonka Blvd, ttinnetonka, 55343
11.50 s/c
_ dai;ed this ZZ°d day of Januax'y ? 19 ?5
Building Inspector
D.,c1:ai:ical Yer.mits:
Eid T,tal:
. ?
, '.
Thompaon Plunbing - Plumbing Permits
Hickory Hill 1735
1737
1739
1741
1743
1745
1747
? 1749
1751
1734
1738
1742
1744
1746
1748
1750
1752
1754
Walnut Lane 1736
1730
walnut Circle 1708
1718
' ?/017.r
1985 BUILDING PERXIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS NUST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For: ?CK
Valuation
: 0000 - 5? 30 ?S?
Date:
Site Address: J7yp ?y/?,C?Gj?y ?{?CL OFFICE USE ONLY
?
Lot: Slock ! Sect/S ub Zc) Erect X Occupancy
Remodel Zoning
Parcel 11 Repair Type of Const
Enlarge l1 of Stories
?
:R
Owner ? ? NE ? /,
}/Z ?
-
Move
Length
Address ?7??j ftjC?CO?7
L Demolish
Grade _ Depth
Sq Ft
City/Zip Code EA6,91J S?? 2 Z --------------- --------------------
Phone qS`( - U 70 APPROVALS
7z-sF}W1?
Contractor gS3-5-93 °
Assessments
Permit 13 `?
? _
Water/Sewer Surcharge
Address Police Plan Review
Fire SAC
City/Zip Code Engr Water Conn
Planner Water Meter
Phone Council Road Unit
Bldg Off - Q-$ Parks
Arch./Engr. APC Treatment P1
Address Variance
TOTAL ?' t; •? i/
City/Zip Code
Phone 6
... ' ? ?
r
- ? ???I? -?_ ? ?• AM, r-aELD a c'OV^9AK??4?' ?
a
i
.??
? r ^
TIiS WAV2ATA !W6 `-' YIMNGiOLii, YIIp1Ei0TA
1 ;tU. 1,?
r
yi? ?rf ?"?
6MCVGC•OCA?a (D,?r Li39phF7EY
Px NL•'F HORIZON HOMF.S
oc ?
-"
?!'90..?
Scale: 1" - 20'
.
DESCAIPTION:
10t 10, Bloek 7, '
q00DGATE 2ND ADDIT7.ON
Mh hereby cer ity thal tnis is a true and CorreCt4eDresentation ola survey of
t' bounderie.=( the lend above Eeserfbed end of fhe lotation ofall buitdingq
ir anr, tnereun, end all vlsiDle encroechments, lf any, fran or on sald lend.
Ftr* seE this 7th dai of JanuarY, 1975.
DGtaQ thls l?k dsv of N°"e'°b°r A 1976 0 E?N, ELD t NPKA& 1NC •
..lh.a.n ?r./•'r tJ
er ,1 . % 1 .
1?vf
C'CT'r' OF 1=AG;AN CF'if31-CL[iP,: S 7?E.fii;'[NAl... A`!J: 760
DA'rE'11 C1ki10l99 '?:CMI-=: 0909;;U'5
IDa
rt!AMG^ F:Of?I--'f3? ]:Nf:,,
;iF'_1.(l `1C1(.l;. M?7 FI'f.f::h;C1R`( li.l: 125.25
2955 9(lU:l. :1'74si1 HI('I;C4RY N5 3.00
.
4
'i'otal Receipl, f=1ip(.7tar.1;; 12805
1;R j, i.`rF,0
1_ELi.F'{ IP7a t!ANCV
?k>k'?FN,? ;{YF?k%I?Y/•Yxk'?'%X??'4(?inN(Y,;Yn%n9FmKM.+?'MM#?i k'":Y:?'?C'm??IK#
1999 BUILDINC PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
E830 PILOT KNOB RD - 55122
651-681-4675
New Conahueflon ReauiremeMs Remodel/Reoair Reauirements
D 3 regisfered site surveys showing sq. H. ot lot, sq. H. of house
und Q roofed areas (20% maximum bt eovemae allowed)
D 2 copies of ptans (show 6eam a window sizes; poured ind. design; etc.)
D 7 sef of energy calculatlons
D 9 copies ol hee preservoNon plan 8 lot plaMed alter 7/1/93
DATE:
2 coples d plan
7 set of endgy calcWaNonf for healed addNtons
1 ske survey tor extedor addHions 3 decb
CONSTRUCTION COST: ?piI
DESCRIPTION OF WORK: P UV
STREEfADDRESS: 04'b
,, I ? a
LOT: _? BLOCK: ? SUBD./P.I.D. VV
Name: Phone N: "I 0
PROPERTY Lart Ili F
OWNER J{(J ?
Sireet Address• I i" ?? q ?
CMy WI / 4 StaFe: ? ziP:
Company: Phone#: f/L_(/`?
' (area code)
CONTRACTOR Sheet Address: /-?Zw0 License #o?W"?!&8 Fxp• i?i4-0
City State: /V Iip: 0?n
ARCHITECT/
ENGINEER Company: Name:
Telephone #: area code (
SheeY
Cffy
Sewer 3 water Iicensed plumber (reaulred for new conskuction onlvl:
Stote:
PenQIFy appltes when addreu change and lof change is requesFed onee permR Is Issued.
Zip:
I hereby acknowledge fhaf 1 have read this applicalion, siate that the inf on Is cortect, a agree fo comply wNh all applicabl
anees. I
StW,P of Mlnnesota Stafutes and City of Eagan ZS'Ign
e ot Appllcont:
atur
OPFICE USE ONLY
Certificates of Survey Received _ Yes _ No
AUG
Registration #:
Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 27 Porch (3-sea.)
O 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Poroh/Addn. (4sea.
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging O 20 Pool ? 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 SidinglSoffits/Fascia
? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bldg.• ? 41 Wood Stove ? 45 Fire Repair
? 34 Repair 0 38 Demolish (Interior) ? 42 Reroof
' Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq.ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
Engineering
Census Code
SAC Code
No. of Units
No. of Bldgs
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation:
.?
SAC Units
% SAC
?
400 Clty of Eapn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
F For oftice use I
I /
(J ?
j Pertnit #: ?-I S 5? I
? Permit Fee: qo_=??_ ?
? Date Recerved: j
i i
I Staff: I
I
------------------
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: _7' o` a-Q 0 Site Address: 1-7 Hd Y-t i Gk c)?' y 44i
? 1 •?. ?_ ?,(ACG??
Tenant: ? a A A/yC( Suite #:
S T S
t
?
RE
IDENT / OWNER Name:
Phone:
J
aAm
Address / CdY / Zip: J 7?9 WCt?1?1 ?` ??cal/
x
Applicant is: _ Owner -
Contrador
TYPE OF WORK Description of work:
Construction Cost: MWti-Family Butlding: (Yes No ?
CONTRACTOR Name: License #: aO.?7S S?
Thomas A.
West ConsVucUon, Ina
Address: yp? e ,R u n
Northfield, MN 55057
City: TEL: (857) 7R5.3712 StaTe: Zp:
EMAIL• west.constructlonOcharter.net .
? S
Phone: Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheel ?• New Energy Cade Worksheet
Category suur„med suhmined
submisslun typE) • Energy Envelope Calculations Submitted
In the last 12 months, has the Clty 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 Plum6er: Phone:
Mechanical Contractor: Phone:
5ewer & Water Contractor: Phone:
NOTE: Plans and supportittg documents that you submlt are considered to be public information. Portions of
the information may be classiiied as non-pubiic if you provide specific reasons that would permit the City (o
candude that the are trade secrets.
I hereby acknowledge that this iMormarion is complete and accurate; ihat the work will 6e in conformance with the wdinances and codes of the City of
Eagan; that I understand this is nol a permiy bUt only an application fw a permi[, and xrork nat to start without a permd; that the work will be in
accordance with the approved plan in the case of work which raquires a review and approval of I•
XT?u,?-u?5 r. C.E-0 X
App icant'S PriMed Name Ap II nYs Signalure
Page 1 of 3
Use BLUE or BLACK Ink
r
For Office Use1 1
Permit City of Ea I Permit Fee: I• a S I
J I
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 BUILDING PERMIT APPLICATION
Date: Site Address: / /Unit
Name: L~GZ d/` - 7" f9 ~Ve Phone:
Resident/
Owner Address / City / Zip:/ % f/ ~f / / 2
Applicant is: Owner Contractor
Type of Work Description of work: _ A,
® ~
Construction Cost:_ j~7®® Multi-Family Building: (Yes / No
Company:x6efm✓t®h c dn57~ 7~ J~1Vh~7(;Contact:
Contractor Address: -~/~Se) L o 1 % 6-e City: 6L°la1-7 4~7
State: Zip: ~3 02 p Phone: ^~~cy
License Lead Certificate /f 7-
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 _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.
1.._
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.
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.
x x
Applicant's Printed Name Applicant's Signature
Page 1 of 3