1395 Lone Oak Rd?CITY DF EAGAN Remarks A ____
Addition S Lot 1 Blk 1 Parcel asm 010 OI
Owner ? - street State Eagan, Mn. 5121
i - -? - Lo
Improvement Date Amount ? Aqnwl Years Payment Receipt Date
STREET SURF,
STREET RESTOR.
GRADING
I
a SAN SEW TRUNK 1968 100. 00 $3. 33 30 PAID
3b*SEWERLATERAL Stub 1972 3578.75 178.94 20 PAID
WATERMAIN
*WATER LATERAL& Stllb 1972 ZO
WATER AREA 6 iS /o • CO COp
STORM SEW TRK 1984 564.30 37.62 15 564.30 C008336 8-4-83
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
i WATER CONN.
BUILDING PER.
SAC
' PARK
L
CI'1`Y QF EAGAN
3795 Pilot Knob Road
Eagon, MN 55122
Zoniny: _
Owrier.
Address: _
Site Address:
Plumber: -
1 agree fo comply wifh t6e Cefy of Eogon
Ordinances.
Q..
Date of I nsp.:
I nsp..`--,--
CITY 9F - EAGAN
3795 Pilot Knob Road
Eagon, MN 55122
Zoning: ?
Owne
Address:
Site Address:
Plumber: _
Meter No.: -
c;?o
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units:
Connection Chorge:
Account Deposit:
Permit Fee:
Surcharge: _
Misc. Charges:
Total:
Date Poid: -
WATER SERVICE PERMIT
Connection Charge:
Account Deposit: _
Permit Fee:
Surcharge:
Misc. Char9es: _
Total:
Dote Paid:
Reoder No.:
1 agree to compy with the Ciry of Eagan
Ordinanees.
By
4 /A /";
PERMIT NO.:
DATE:
No. of Units:
RESIDENTIAL
BUILDING PERMIT APPLICATION ?!'a ? • a-?
/ CITY OF EACAN
?a ? 3830 PILOT KNOB RO, EAGAN MN 55122
651-681-4675
New Conslructron Reauiraments
• 3 regislered sde surveys showing sq. ft. of bt. sq. R of house, and all roole0 areas
(20%muimum lot coaerage allowed)
. 2 copies of plan showing Oeam 8 wmdax saes, poured fountl design, etc }
• 1 set of Energy Calculatwns '
• 3 copies of Tree Preservalian P,lan rf lot platted aRer 711193
. Rim Joisl Detail Opuons selection sheef (GEgs wdh J or less uniLS)
DATE Id?? 1 I G Z-
RemodellReoair Rauuirements
. 2 copies of plan
• 1 sel of Eneryy Calcula[ions Por heated additians
• 7 site survey for extenor adCNOns & Oecks
. Indicate d home servea by septic system for ad0itbn5
VALUATIOtY UI0(20 60
50
SITE ADDRE55 I'3q !j- LOjr12 OGK RC? 15r`J I Z-I MULTI-FAMILY BLDG _ Y _ N
TYPE OF WORK 9???IGC?{'Y1-f'd?l"? fJT IN1Y1dOVVS FIREPLACE(5) _ 0_ 1_ 2
APPLICANT
STREET ADDRE
TELEPHONEpt
PHONE #
FAX #
PROPERiYOWNER K_ f II?J??U11?? TELEPHONEt?
COMPLETE FOR "NEW" RESIDEN7lAL BUILDINGS ONLY
Energy Code Category _ MIV tiESO"f.1 RCI.I:S 7670 Gxl'EGORI' 1 ;4IINNE50"17A RCI.ES 7672
(J su6mission type) • ReSidential Venhlahon Calegory i Worksheet Submitted • New Energy Code W orksheet Submitted
• Energy Enveiope CalculaUons Submitted
Plumbing Contractor:
Plumbing systcm includes:
Mechanical Contractor:
Mcctuviic.il s?stcm includcs:
Sewer/Water Contractor:
Air Conditionmg
Hcat Rccovcry Syslem
Fee: 590.00
P,t
„
Phone#["' 1 " 4` ?r- ?
Pcc: -370.00
Phone #
I hereby acknowledge that I have read ihis application, state that the informaTion is correct, and agree to comply
with all applicable State of MinnesoTa Statutes-ancl City of Eagan Ordinances.
?? ?`?? ?? ? -
Signature of Applicant
------- -'-------- ----------------------------------- °------------------------------ --'---------..
OFFTCE USE ONLY
CeRificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
4Vater Softener
Water Heater
No. oF 13aths
_ Phone # _
L.awn Sprinkler
No. of R.I. Barhs
,l i?+ i
CITY STATE_ZIP
/1" RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OF EAGAN ?q al
? ?L 3830 PILOT KNOB RD - 55122
ri 651-681-4675 ? ?)6
New Conatrucfion Reoulroments RamodellRewir Reauiremenh
• 3 registered si[e surveys showing sq. ft of lot, sq. fl of house; and all roofed areas • 2 copies of plan
(20% maximum lot coverege albwed) . i set o( Erergy Calculafrons for heated additbris
• 2 copies of plan showing beam & window sizes; poured found design, etc.) • 7 sile survey for ezlerlar addNOns 6 decks
• 1 set of Energy Calculatlons . Indicate if hane served by septic system for additbre
• 3 copies of Tree Preservation Plan if lot platted after 711/93
• Rim Joist Oetad Optbns selection shcet (bidgs with 3 or less uniLs)
' I cs-d
DATE 41111 0 Z VALUATION ?000'
JOB SITE ADDRESS 1311°1 S LtSY1 r (f?CX- 2-C7•
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER I+V1. U!--?
TYPE OF WORK I?) L' S I Gl2 , l0 Pcl2?ll fY7? FIREPLACE(S) _ 0_ 1_ 2
APPLICANT & QX-A'r LPCI/i+,? W i rJipeu.i PHONE# 9.?L S°I 1'3y`?O
ADDRESS I4l.I Sb C, L,(-_? iprt- ?- ZIP CODE SS ld
PAGER # CELL PHONE # Fax # 95)--';iq I-`fia go
NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLE F'?????
?: aPR z 5 zooz ?U
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 ?L L
(check one) - Residential Ventilation Category 1 Worksheet Submi ed ?
- Energy Envelope Calculations Submitted Rv
_ MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Plumbing Contractor: Phone #:
Plumbing System Includes: _ Waler Softener _ Lawn Sprinkler Pee: $90.00
Water Heatcr No. of R.I. Baltis
Na. of Baths
Mechanical Contractor.
Mechanical Systcm Includes:
Sewer/Water Contractor.
_ Air Condiboning
HeaL Recovery System
Phone #
Phone #
Fee
$70.00
All above information must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant ? •
Certificates of Survey Received _ Tree Preservation Pian Receive _ Not Required _
Updated 2002
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EACAN
3830 PILOT KNOB RD - 55122
851-681-4875
New Conshueflan Reaulremenh 1 Pvq( Remodel/Renalr ReauiremeMs
? 3 reglaTered alte wneys ahowlny sq. H. of lof, aq. H. of house
and gj( rooted areas CM mmcimum bt coveraae allowetll
> 2 copies of plons (ahow becan & wlndow aizes; poured fnd. design; etc.)
> 1 sel of energy calculallons
> 3 coples of hee Pretervatlon Plan If lpt PlpHed afte( 7/1 /93
DATE: ') /s
DESCRIPTION OF WORK:
STREET ADDRESS: /. /- 42Z -
LOL• ' BLOCK: 1 SUBD./P.I.D. #:
2 coptes of plan
1 sel of energy cdculallans far heated addiHOna
t sfle wrvey fw wctedor atldiNOns & decks
CONSTRUCTION COST:
a5oa.°°
a
Name:ZL??c????i,? - Phone u: ??1Y ? -?9
PROPERTY
OWNER /
SheetAddress:1??5 Lvn.% iV?2
City State: ? vP:
Phone #:
/ (area code)
CONTRACTOR Sheet Address:/ ? ? ucense aao9? Exp.
city stafe: 46, Zip: s?3
ARCHITECT/
ENGINEER Company: Name:
Telephone #: ( )
Streef Address: RegisfraHon #:
City State: 21p:
SewaAwater licensed plumber (if instalflna sewerhvaterl: Phone #:
1 hereby ackrawiedge Ihat I have read thts cPPlfcation, stafe Mat Me iMortnafion is
o} Minnesota Statutes and City of Eagan Ordinances.
Certificates of Survey Received _
Tree Preservation Plan ReCeived _
Signafure of Applicanh
OFFICE U E ONLY
Yes No '
Yes - No - Not Required
with atl appdcabie Stote
LOT: ` BLOCK: SUBD./P.I.D#:
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122 ? H
851-681•4675
New Construction Requirements Remodel/Reoair Reauirements
D 3 registered slte surveys showing sq. ft. ot lot, sq. ft. of house 2 copies of plan
and all roofed areas (207* maximum lot coverage allawed) 1 set of energy calculofions for heated additlons
D 2 copies of plans (show beam 8 window sizes; poured fnd. design; etc.) 1 site survey for exterfor additions & decks
D 1 set of energy calculatlons
D 3 coples of free preservaHOn pian If lot plaHed affer 7/1/93
D Rim Joist Detall Optfons selecHOn sheef (buildinas with 3 or less unNsl
DATE: zr CONSTRUCTION COST: / 10 Q
? L rCR?SS W ) N OOin!
DESCRIPTION OF WORK: /tli5lv If multi-family bidg., how many unRs?
STREETADDRESS: 13/ S-- ? ? & ofo
Name: & C/? C. ? Phone
PROPERTY Lan Fint
OWNER Street Address: °rv r vA
City rA e A? State: Zip:
Company: ?A ? 1 d S?? ??? C??s hone #:
CONTRACTOR JQlcf
?951- y?9? S L.zL.
(area code)
StreetAddress: r? ? ? ? ??? ?? Lr\ License#
City ? -411'? 7W1- ? State: ?
ARCHITECT/
ENGINEER
Telephone #: (
Sheet
Cily
Sewedwater licensed plumber (if installina sewedwater)
0 Y Exp. 32416)
Zip: `/ Lj
- Name:
_ Regishaffon
Slate: Zip:
Phone#:
I hereby acknowledge that I have read this application, state that the information is correct, and agree to
comply with all applicable State of Minnesota Statutes and City of ^Eagan Ordinances
Signature ot Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No 2- L^?23
Tree Preservation Plan Received _ Yes _ No _ Not Required ?
2004 RESIDENT7AL BUILDING PERNIIT APPLICATION
! City Of Eagan
r? 3830 Pilot Knob Road, Eagan MN 55122
? Telephone # 651-675-5675 FAX # 651-675-5694
? I U ??
New Conshuclbn Reouiremenls RemodelA2eoair Reouirements icaU3e?YnTi
3 registered sile surveys showing sq. ft of IoL sq. fL of house; and all roofed areas 2 copies of plan ?ei?'s? ?i.?''
°!-
(20°h maximum lot coverage allaved) 1 set of Energy Calculalions for heated additions 's'xP..]an__err.? -?. ???`_-?`
?`.2 coples of plan showing beam & window sizes; poured found desfgn, efc. 7 site survey for additlons & dedcs
s-k 11931
1 set of Eneqy Calculations Addibar - indicate ilonsite septic system ??&?B?ftx.:??? ?
3 copies of Tree Preservation Plan if bt platted afler 7/7793
Rim Joist DeislOptlons selection sheet (61dgs wifh 3 or less unils
Date r /I1 /?q i 3q ??
Site Address ? p ne aQl? 1('c4 Construction Cost Dt)
UnitlSte #
Description of Work
Multi-Family Bldg _ Y2?rN Fireplace(s) _ 0 _ 1 _ 2
Property Owner Ildlt-em Telephone # ( (p5( ) (159)'
Contractor
11b?1?1? SiJi n
Address P PYu
State
v
,J
Zip 55 2-'-F /
City AAole V i
Telephone # ( qs'Z) ?{
COMPLETE THIS AREA ONLY IF CONSTRUCTIN6 A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Enett]y Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculatlons Submitted
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 Q
I hereby apply for a Residential Building Permit and aclrnowledge that the info tion is complete and ccurate;
that the work will be in conformance with the ordinances and codes of the Ci si anct of MN
5tatutes; 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 appmved plan in the case of work which requires a review and
approval of plans.
3h2. BWOS
Applicant's Printed Name Applican s# ature
FROM
411? tty of Eaian
3830 Pilot Knob Road
Eagan MN 55722
Phone:(851)8T5-5875
Fax:(651) 675-5694
(WEQ)FEB 4 2009 15:31/ST.15:30/No•6802942553 P 2
? Foc;oilroiuu`se -- - - - - - -
? I
? P@Mtil C; ?cz, 4? j
i Permil Pee: q4
?
i Dete Recel?ed' ? - `-Y i
j Stafi
I ------------------
2009 RESIDENTIAL BUILDING PERMIT AF'PLICATION :?L{1Jtol 2 "'?
a,te: Z- 3`09 scendd,ims: on 134k Q00
Tenant• V v11ei' Suite #'
RESIDENTlOVYNER
6Z -3ZI'Z6iK
Name: /sPllL S• ttf?f?l?-P pt+ane: 6 1
AddrB3s I City 1Zip: 1319'5 L. I7 (.'Cle k000/?? Laip/'1
Applipnt is: _____ Owner _A Conhador
TYPE OF WORK Description of work; kitMAvF m([ i%0hl.a if (3 4ekl)
' J
Constn?ction Cost: A?"? c?o . ? Mufti-Family Building: (Yes _ ! No ?
CONTRACTOR Name: 4f3/17tP License #: ?O l14y01
Address: 1225 l/PrmdMb" S{-0W-
City: ?G`?5'+!h/C State. Zip:
Phone: Contact Person: ? r/ /&i
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rufes 7672
Energy Code . Residen6at ventiiation Category 1 Worksneet • New Enargy Code worksheet
Category subminea suumitted
(4 submiBEion type) • Energy Eweiope CatwWtbns SuDmineO
In the last 12 months, has the City of £agan issued a pertnit for a similar plan based on a mastar plan?
_Yes _No If yes, date and address of master plan:
Licensed Plum6er: Phone:
Mechanical Contractor, Phone:
Sewer 8 Water Contractor. Phone:
NOTE: Pfans and supporting documerrts tlrat you submlt ane considered to be publlc, lMomietio"n: ?Aorti
the informadort m'ay be classired as non-public if yov provide ,s/iecif'+c reasorts that would permlt the C. . ...
;
El
-
conc/ude that fhe are f/ede secrefa, `
I herepy acknowledgp Nat tnfs ini0rmation is compkte antl accur8te: that ihe vrorK vnll be in conTomianeC with the
Eagan: that I understand this is n(yt a pertnif, but only an application tor a pertnit. and i6 rrot to start wi
atcordance wkh tM approvld plan in the tase of work which requires a review d 1 oVam.
x (?r-ea .t c+hlarrr?
Applicant'siinMd Name
and codes of tM City of
that lhe woAC will be in
Page 1 af 3
FROM
_ Flreplaee ? Porch (3.Season) _ SWrm Damage
Garage Porch (4Season) Exterior Alteratlon (Single Famtly)
? Deck Porch (ScreeNGaaebolPergola) _ ExteHor Atteration (MUItl)
lower Level Pool _ Mlscellaneous
> DO NOT WRITE BELOW THIS UFlE .
SUB '1'YPES
Foundatlon
? Single Family
Multi
07 of _ Plex
Acces9ory Building
woRK rrPes
New
Addition
Y Alteratlon
Replace
DfSCRIPI'ION
Valuation
Plan Revfew
(25°.6_ 100% z
Census Code
# oi Unlts
# of 6uildings
Type of Constnactlon
Interior Improvement _ Siding _ DemolISh Building'
Mwe Building _ Reroof _ Demollsh Intarior
Fire Repalr Windows _ Demallsh FoundaUOn
Repair _ Egress Wiridow _ Water Drmage
'Dom WlNon ot Mtire buildin9-give PCA handout to appllnnt
? Occupancy 11? MCES System -
? Code Edltion oqavZ SAG Units
Zoning 4 - I City Water ^
? Stories Boostor Pump
Square Feet - PRy "
? Length - Fire Sprinklers '
? Width ?
(WED) FEB 4 2009 15:32/ST.15:30/No.6802942553 P 3
REQUIRED INSPECTIONS
Footings (NeW Bullding)
Footings (Dack)
Footings (Addition)
Foundation
Drain Tile
Roof: -Ice & Water -Final
? Framing
Fireplace: _ROugh !n _Air Test _Final
Insulation
Meter Size:
Reviewed By:
Base Fee
9urcharge
Plan Revlew
MCES SAC
City SAC
tltilrty Connecfion Charge
S8W Permit & Surcharge
Treatment Plant
Sheetrock
Final ! C.G. Required
? Final ! No C.O. Required
? HVAC
? Other. A6 /tirTJc[ h?T Si-?? ?w S?Mf
Poal: _Fvotings _AiNGas Tests _Finaf
giding: _Stucco Lath ___Stone Lath .,_Brick
Windwas
_ Retaining Wall
Building Inspector
AoclL.yi
?73 7c
7 9_v_
Copies
TOTAL
Use BLUE or BLACK Ink
For Office Use I
I ''7 I
41~1City of l Eapn I Permit #:1~
Permit Fee:
3830 Pilot Knob Road I
Eagan MN 55122 1 Date Received:
I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 Staff: I
L----------------I
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Dater Site Address: Unit
F ,
1 Name: hl Phone: (YSI ° c~L~V
RESIDENT / 945 6 L
OWNER ~ Address /City /Zip: tt
j § Applicant is: Owner Contractor
TYPE OF WORK ; Description of work: ' UV I C~
Construction Cost:, a~ Multi-Family Building: (Yes / No )
Company: h6k)°lW11, WC C - Contact: J ( U awl,
3 Address: C1~~C4X S1L 143 City: woguus
CONTRACTOR /lii 2 / J q
State: Zip: JJ~`f S Phone: L ~J ° S`f J ~~S IS
1
License #:S1I) Lead Certificate
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:
_ - _ _ W-.7,_..,. - . _y._ _ .
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 they 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.aopherstateonecall.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 B - :Ze must be completed within 180
days of permit issuance.
x x
Applicant's Printed Name ppl' nt's Signature
Page 1 of 3
� , �'t � ♦:, r t'�' 1�'r .i�.•V14r� v�i ' . • � . �.
- � . . . � �r1 .�.• ,. . � . .
� ' • , ` ' �t. ' ~ �,� � � • Use BWE or 6LACKInk
� ,� • • . � . . �------- --- ----.-
. � For Qtticv Uae� �j
�Cit of _ : . . . '
�a a� . . , Pa����. ;���s �
� .� � � . ,
3830 Pilot Knob Road � ' � Permit Fee; O �. �S' i
, , �
Ea9an MN 58122 . . � ,
Phone: (651) 6T6-66T6 . � Dete Received: rI /j�. �
I �
Fax: (661) 676�6694 . � stan; �
J .i. !����������������I
� 20�1 RESIDENTIAL BUIL`DING�PERMIT APP�icaTiorv
Date: ' Slte Addre�i: � . . . . Unit�;
Name: � � ��� ��-� ... •'' . c ��
'k '�
.
. .
.
RESIDENT I `�� �" . �" , ,� . , ---- Phona:,�(' L�j -��G
, . . . .
.
OWNER . Address/Ciry I Zip; 1•� C� � � ��� '�` . :•�� ��. �'
..
_ �, ��,�-�,� 3 _.--.
F �i '�� �tf
.
` d���
Applicanl Is: 3wn�er � .�'•�.Cattrectot•� � � •. ' � � � �
,.,,
TYPE OF WORK Descriptlon of work: ���.� 1:� G�i��2.,i4(,r� �j�
� Construction CasG ��`�'�'�,��G`�� � � MuIU-Family B ilding: (Yes I No�,J�
Company:''7rir✓iN���/����,_Contact:��C'!h%' .5��������,.
Address:__Z�'��/ 'I.����L1L� ,IQ�I � ' ' Ci � L� , �
CONTRACTOR , .__.. , tY: _ f� j
State:,�:,,Ztp:�C'��' - . .Phono:� '�.5�. �9�D b I
� . . ., . .�� ..; .»
�:. �
. � ucense�:�D 3 D,��'x.r� :,' i.vad��i'tlflcate#: /l/'!¢,7= �',�.3 7 3-'/
-
N I:.�t, . . .
If the project is exempt.from lead certlf(catlon, pfease�explain why�tsee,P�ago 3�for addit(onal information)
, �, ;, , .r . . .
. . � ..l..�ti� ,.<��•��f�,��•`i��'� t.'. . .
. .. . , . . . .. � .. • '�C,. .r%y�q,.i ,�,:' .
COMPLETE THIS AREA QN�(F�C4_RUC71t�Q A E____W 6UILDING
. , , .
In the last 12 months,has tha Ciry ot Ea9an(s�ited a pe,rmlt for.a slm0ar.pian baaed•on e master pian?
_Yes _No If yas,date and address of master plan: ' • �' .
. '�� .
t,7censed Plumberc Phone:
Mechanical Contractor. ' Phone: I
Sewe�8.Water Contractor. � ` ' ' �� • ' ' . Phone;
NO1'E:Plans and support/ng documen tha�yo.u�;subm,lt��.�p cqns/d�retl,to�be publlc Informadon. Portlons of
. the lntormatlon may 4e�class/�/g�!as��i�:��ublfC,lf yvu�o,Yf 5��;�s� '�asons that wou/d erm
. . . .��cd�cfarlA�lia�t:trie�:ar�. �F�;�; . . A. n the C1ty co
. . . .., . • �.�•, . ._ , �xad�:secr+e�s.
CALL BEFOR�YOU DtQ. CaA 0ophor8,tatv Oni.CiAjpt � ���''•, �:. �. �,," ,�.;".•:'�'�. .;�.� .. .
Galae.you Inten4 lo di9 to r ���ei p�� «� ���=Ia proi9c�lon eflaln�t�underyround uuiny dama e. Cau 48 hours
acalve er�p.ro�xfd utulti,�, � , �
:4;�.:stM}.�.ti. .�f:e`.�it '.a :r•��ir�r••,�'��; r .•° .
I hereby acknowtedfle thal thts InlortneUon Is�COmpl8l9 8(�d BCCUrale;St18t!h8 YvO�fc WiU�b9.ln Cpn(prtpancg wlth lhe ordinances and codes ot u�e City oi
EBgan: that I understand Uils Is not a pq'rmlt, b6t Only 8n sppQc8Uof1(o(e pem�lt, �txl,.yp(k li,(10l l0 al8ft wllhpul 8 perrr►it: lhaf (he wo�Sc will ba in
accordance with ihe approved plaq In tha'ceso of wncic whlch requ�'es e rovlow and�eppFovai of.plot�.s,' '
Exterior work authort=ed by�buildln�permlt Itsued In accordance with tha M(nne�ota 8tato 6uliding Coda muat be completed wlthin t 80
days of permlt lssuance. � , . . ,
X Sf�''G� S�i�O h�/�214�E-,2. . , ' .
Applicant s Frinted Name x
Ap cant's S�gnature
, Fe9e 1 of 3