1425 Lone Oak RdCITY OF EAGAN Remarks fe4agea.fr'd
Addition ZEHNDER ACRES Lot 5 Rlk 1 Parcel 10 88800 050 00
Owner 'yahlia f). S+ratA Street 1425 Lone Oak Road State Edgdll. MN 55121
? Improvement Oate Amount Annual Years Payment Reoeipt ' Qate
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 440 1968 100.00 3.33 30 Paid
*SEWER LATERAL 970 2,415.00 120.75 20
WATERMAIN
*WATER LATERAL & St11US 1970 ZO
WATER AREA ?
STORM 5EW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 450.00 38005 8-11-93
BUILOING PER.
SAC
525.00
PARK
CITY OF EAGAN
STls Pilof Knob Raed Eagan, JiAN S5121 4 ?
PHONE: 454-8100
BUILDING PERMIT ?_SIDIYG Receipt
-../
To be wed Mr RE-1200FING & Esc. Value $6,500 pme Jut7e 21 1 q 83
Site Address 7495 j,nna [lak Pnari Ered ? Occupancy R-3
lot 5 Block 0 Sec/Sub. Zehnder Acres AIter ? Zonin9
parcel 10 BF,R(1!1 ?c)n 00 Repair ? Fire Zone
Eniorge ? Type of Const.
W Nume R,nroe Sf'ranrl Move
O # Stories
? ; Address _ 11a25 ?.onP Gak Ftnad Demolish p Length
U
Citv.Eaea.xl 55121 phone Grode ? Depth 5q. Ft.
zp Nome - The ()„ambT.4'O
8? Address 2173 Kasota Ave.
?- r,.., St. Paul 55102m.,,.._ 646-7601
iove read this opplicotion and stare that
id ugree to comply with oli appiicabie
and Ciry of Eogan Ordinences.
Signaturc of Per?nittee
Zme Quimby co.
A Building Permit is issued to:
oll work sholl be dona in occordence with all applicuble
9uildinq Offitial
Approvala Fees
Assessment Permii 612 50
Woter 8 Sew. Surcharge
Police Plon check
Fire SAC
Enp. Water Conn.
Plonner Water Meter
Council Rood Unit
Bldg. Off.
APC Total $66.00
on the express conditiw? thar
Statutes and Ciry ot Eogon Ordinances.
Permit No. Permit Holdsr Misc- Permit No. Holder
Plumbing
H.V.A.C.
Wall
Water
Disp.
Sswsr
Eiectric
Inspectian Date Insp. Other
Footingt
Foundation .
Framing
Rouyh Plbg.
Rouyh HVAC
Inwlation
Final Pibg.
Finel HVAC
Final
Water DasCribe Location:
VYell
Sevuar
Pr. Disp.
CITY OF EAGAN
` WATER SERVICE PERMIT
s830 Pifot Knab Road
P. O. Box 21199 PERMIT NO.: '-
Eagan, MN 55127 DATE: :?-11- P. 3
Zonirig: IVo, of Units: '
Owr1ef. :,orghild Strana
Address:
Site Address: 1425 Leue Rd L5 ?e'ir:ccr 9cres
Plumber: Wenzel
Meter No.: Connection Charge: 450•00 nd
Size: Atcount Deposit:
Reader No.: Permit Fee: 10.00 pd
1 esme hcomPly wkli f4 City of Eagon Su?charge: •50 pd
O?dinonaL Mtst. Charges: ").00 p d me t n r
Torot: 15.Cn ltorn
By Data Poid:
Date of Insp.: Inap.:
ctTY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road .'.??:' r)
P. O. Box 21199 PERMIT NO.:
Eagan, MN 5512? DATE:
F? ?
Zoning; No. of Units:
Owner: SCtanci
Address:
Site Address' ?r) I,oile 0??, F.c! L5
Plumtrer:
5 '
1 ageee M eanply wub the Gfp of Eagan
Ordinsnoer.
By
Dote of Insp.:
100. 1"n
Connection Charoe: 425• Q'.) ncl
Acaount Deposit:
Permit Fee:
Surc.hnrge:
Misc. Choroes:
Totat:
Dote Paid:
cirr oF ea"N
3795 ilkf Keob Read Eagan, MN 55112
iHONE: 4548100
N° 8177
BU1L1^+ING PERMIT RE-SIDING • Receipt # - 7;?'ad
Te M usad 4or RE-ROOFING fi Est yalm $6>500 pOfe June 21 19 83
Siro Addreu 1425 Lone Oak Road Erecr
? R-3
Occuponey
Lof 5 B lock 0 Sec/Sub. Zehnder Acres Alter Zonirq
ponoel # 10 88800 050 00 Repmr ? Fire Zone
Enlarge ? Type of Const.
W Na,,,? _ Sor¢e Strand Move
?
# Stories
? ,e,?? 1425 Lone Oak Road Demolish ? Length_
c; EaQ an 55121 p,,, Grode ? Depth Sq. Ft._
? No,T,@ The Ouimby Co• AvOroro1s Feas
o
?? Addrea 2173 Kasota Ave.
? r;,,, St. Paul 55108n,___ 646-7401
Name _
Addrese
I hereby ackrwwledga that I have read this opplication and stole ihat
1he information Is correcf ond ngree to comply with all opplicable
Stute of Minnewto Statutes and Ciry of Ea9an Ordinances.
Assessment _
Woter & $ew.
Police -
Fire
Erq.
Plonner -
Council _
Bldg. Off. _
APC
$iBnoture of Pertnittee -
e uim y Co.
A Building Permit is issued to: _
all wark shall be done in otcordance with all `ap,y?liwble Stote Minnewta
Buildinp Officiol / //
Permit bL.7U
Surchorge 3.50
Plon check
SAC
Water Conn.
Water Meter
Rood Unil
Taai $66.00
_ on fhs exprest condition Ihni
ond Ciry of Eaqan Ord7rwnces.
7 CITY OF EAGAN Include 2 sets of plans,
? 1 site plan w/elevations &
, BUILDING PERMLT APPLICATION 1 set of energy calculations.
Ut4r
14?3
To Be Used For?j?;q.ooc,a???}?;y?p,N6Valuation -? (? ??o o`? nate j-
site ru3aress ? 14 ?.$ [r ? IZ f C D,/n? OFFICE U5E ONI,Y
Lot ? Block D Sec./Sub. ZeknAEi' ry? Erect OccupancS'
Parcel #: 10 ?-gTOO D`-'O b Alter ? Zoning
? Repair Fire Zone
O?rmer: o = AN O Enlar5e _ ZYPe of Const.
Address: 14 IS LD.JE 604K p_ M°ve # Stories ft.
- Denrolish Front
City/Zip Co3e: L=.A G Ak} Grade ! Depth ft.
Phone #:
Contractor: O _ (by Address: ?113/ Il?OTh /?J?
City/Zip Cocle: tj i N N ? D
Pnone #: lo ?f-b - 7 4 i
Arch./Fng.:
Address:
APPROVALS FEES
Assessuents Permit a L S?
?4ater/Sewer Surcharge 3 • SD
Police Plan Check
Fire SIc
Encj, Water Conn.
Planner ter Meter
Council ad Unit
Bldg. Off. -2 -
APC `
City/Zip Code:
Phone #:
Z+OTAL `dc)
REQUEST FOR ELEC7RICAL INSPECTION ee-ooooi-os
4' [?p
.i ., I , See instructiens br completing Ihis lorm on back oi Yellow copy. ?y yp7 ?%
? 94344 "X" Be/ow Work Covered by lhis Request
Nerai u.Ad Reo. "" Tvoe oi euiimne Aocliancea WveE EpuiVment Wiretl
Home Range Temporary Service
Duplex Water Heater Li,yhtiny Fixtures
Apt. Bmlding Dryer Elec[ric Heahn
Commercial Bldy. Fumace Silu Unloader
InAustnal BIAg. Air CondiLOner Bulk Milk Tunk
Farm mHr Per.i Y nthrr l5ucc,fV1
[ er Suenly Other Other
Comuute /nsoecUOn Fee Be/aw
# Fee ServweEnlmnce5ize d Fae Fande,s/SubfexAers N Fea Cvcwts
- ttU U to 200 qm 5 0[0 30 Am s , O 0 tn 30 An!
A62ve 200 qmps 31 to 100 Amps 31 to 100 A
Swimming Poal Above 700_Amps Above 100_AmPs
Transtormers 7ngation Booms Parval.'Olher Fee
Signs Special Inspectwn ^7
$ TOTA F
HerrHrks 4 G 1 ?
.
RouBh-in r ???? I. I pehe EI
Insctor, hereby
cerLly ihet Iha above
Final (?e?? ?
?? inspecLOn hes been
mede.
thM repuest volO 1B montM Irom
This repves? void
18 months (rom S Q O
D 94344/,?,,dov
Hequ?st Daie roCI/I Rough-m InsUert wn
Hepwretl? EDReady Now Q WpII Nouiy Insoec-
Sune 30, 1988 ?Yes MNn o r When Ready
.'Q Licensed Elec[ncal Convactnr I hereb
y requast insoaction oi abova
? Owner electric»I work installed at'
Sireet Address, Box or qoute No. Ciiy
1425 Lone Oak Road Eagan
ecuon o. Township Nama or No. Fanue No. Cnunry
Dakota
OccuuantlPRINTI Phone No.
Dave Kennedy 454-4545
Pawer Suppher AtlAress
N •S,p. Ca i2eIQ
Electncal Contractm ICompany Nnmel Contracmr"s License No.
Corrigan Electric Company 039549 8
Mailinq AdJress (Convacmr or Owngr MekinP Josiailavon)
P. . Box 475, Rosemount MN 55068
AuN rz d Se?ature (Convactor/ wner Mzking In st:+llauon) Phone Number
423-1131
MINNESOTA STATE BOryyu OF ELECTNICITY a ? THIS INSPECTION PEOUEST WILL NOT
Gr.99s•Midwey Bltlg. lioom N-181 BE ACCEPTED BV THE STATE BOARD
1821 Untversitv Ava.. St. Peul. MN 65104 UNLESS PROPER INSPECTION FEE IS
Phone16121692-OBOD ENCLOSED.
(09 5(n
2005 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: smgle fattlily dwellmgs & townhomes/condos when permits aze required Tor each unit
Date l.2 / -?q / C)
Site Address j qa!!?- Luv\ e
? - OCXL /LI`/ Unit #
PropertyOwner ?0 a, N-? L 0Olf-(?)R) 1.1 Telephone#(60
Cantractor ?"
? ,t ?_
S ?i?
Street Address ?? \ ? ?? ? S ? • ? ?/ . `?l' f U ( City ?
State ?V\ N Zip Telephone # ( ? ) V ?? • ?y 1 z-
Bond #: Eapires:
T6e App6cant is _ Owner ?`Con[ractor _ Other
Add-an or alteration to eaisting dwelling unit $ 30.00
furnace _Additional _Replacement
air exchanger
airconditioner _New _Replacement
other
State Surcharge $ 50
Total
I hereby apply for a Residential Mechanical Permit and aclrnowledge that the informahon is complete and accurate; that the work will
be in conformance with the ordinaiices and codes of the City of Eagan and with the Mechanical Codes; thal I understand this is not a
pernut, but only an applicaUOn for a permit, and work is no[ to start without a pernut; that the work will be in acwrdance with the
approved lan in the case of work which requires a review and approval of nians.
?? 4./rU 1 ?c'vp m 9 1 -';41 ^\ T I' ?2 9?r ? ?I
Applicant's Prin ed Name Applic 's Signature I'. n
?i iIJN 2 8 2005 ,?
o a?z 2127054
?
? ,< o 0
x o c' W w ? ?
? j
CC x Z 90 LL ? F W
d
t; O
° ?
C7 Z=
? yU ? ? Z „J E W
Lf) ? v? Q ,; o¢
pO W El 3: ?, ?...?
?N
U? ? w 6 W W Q 2 ?...?
C ?
THIS ASSIGNMENT is made and entered into the ? day of GL ,Z 2003,
by and between EILEEN A. KENNEDY, a single person (hereinafter "ASS NOR") and the
CITY OF EAGAN, a Minnesota municipal corporation (hereinafter "ASSIGNEE"). ASSIGNOR
and ASSIGNEE aze hereinafter referred to as PARTIES ("PARTIES").
R'ITNESSETH:
WHEREAS, ASSIGNOR is the Grantee of certain easement rights pursuant to an
easement dated 7une 28, 2000 from leffrey T. Zottneck and Kimberly Zottneck, husband and
wife, in favor of ASSIGNOR ("EasemenY');
WHEREAS, ASSIGNOR desires to convey her rights in the aforemenrioned Easement
to ASSIGNEE for public street and utility purposes;
NOW, THEREFORE, in consideration of the foregoing recited facts, the terms and
provisions hereinafter contained, and for other good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, it is hereby agreed as follows:
1. ASSIGNOR does hereby assign to ASSIGNEE and its successors and assign any and
all right, title and interest that the ASSIGNOR has to that certain Easement dated the
June 28, 2000 and recorded June 29, 2000 as document number 1701301.
2. ASSIGNOR further agrees and hereby assigns, grants and convey unto the City, its
successors and assigns, a permanent easement for public street and public utilities,
over, across and under the following described premises, situated within Dakota
County, Minnesota, to-wit:
The East 25A feet of the South 170.00 feet of Lot 5, Zehnder Acres.
The assignment and grant of the foregoing permanent easement for public street and
utility purposes includes the right of the City, its contractors, agents and servants to
construct, reconstruct, inspect, repair and maintain a roadway and erect and maintain
signs in conjnncrion with the publids use of said roadway and appurtenances and any
signs erected in conjuncrion with the use of the roadway and appurtenances.
MUNTCIPAL NOTTCE OF SPBLL PERMIT APPLTCA pN
DAAp'PA COUNTY $NVIRONnNTAL MAHAGSMENT AEPARTHENT
WATER 14938 Galaxie Avenu?es AppleTValYsy?NMN 55124
Tel (622) 891-7011 Fax (612) 891-7031
DAT$t Hdy 20, 1893
TO: Toxt Colbert/Wayns $phwanz
PRDM: Weter and Land Idariaqemeht
REt Well Permit /; 93-9107
. MunictpaliCy : Eagan
8ax #t (612) 681-4612 ?
.
Well Type:,-Sealing -?
Reviewer : swengon
NOTICHs
The Water and Land Management Bection of the Dakota County Environmerrtal
Managem9nt Department has reGeived the Poilowing parmit application for
the well described. If you Yeqaire futhar revfew of tha appliaation or
if you have any queatione or aonaerns about it, contact the Environmental
Bpeciall8t listed above or our offioe at (612) 891-7011. If there ie no
response from your office within 24 HoORS (excluding weakands and
holidays), we will assume that you have no objeations to the iesuanae of
the perm3t. Please note xhttt permit issuance is always conditioned on
the permit applicatlt's observance of and aompliance with all applieabie
laws and oodes. A copy oE the well permlt vill be farwarded to your
oPPice when completed.
WELL CONTRACTOR INFORIKATION:
Johnavn and sons Drtlling
Appliaation Recid: 05/1811993
Antic3.pated Drilling/&ealinq Date: Time; .
L,OCATION QF WSLI„
PI,S Conrdinqtes ;, se ; sw se gee 44, Town 27 , Rnnge 23
ilell Location 1425 Lone 6ak Road
Prcperty pwner aavid ICennedy
Well Owner Ddvid Kannedy
PTD Nwnber - _ ?
wsr,,L =NFORMATION:
lliaraeter A
f:asing depth 193
??sl depth 200
175
Aqu3fer Vnconsolidated Ssdiments
COLIIdENTS :
= 4 -
I
?
612 891 7031 05-20-93 01!OOPM P003 #42?
g67azy
STREET EASEMENT DEED
THIS TNDENTURE, made and entered into this day of
&UUE?%3f_!L , 19'zo?'$, by and between DAVID J. KENNEDY and CAROLINE
A. B. KENNEDY, husband and wife, as Grantors and VI[VCENT J. KEI3NEDY
and EILEEN A. KENNEDY, husband and wife as joint tenants, as
Grantees.
WITNESSETH WHEREAS, said Grantors are the owners,of the tracts
of land in the City of Eagan, Dakota County, Minnesota, legally
described as follows:
The East 30 feet of the South 170.00 feet of Lot 5, Zehndec
Acres,
NOW THEREFORE, the said Grantors in consideration of One ($1.00)
Dollar and other good and valuable consideration to them paid by
Grantee, receipt whereof is hereby acknowledged, hereby conveys,
warrants and dedicates to said Grantee, its successors and assigns,
a nonexclusive easement for street purposes, together with the
uncestricte3 tight to improve the same, the following described
tracts of land, together with the right to lay, maintain, operate
and repair utility lines over and through said above tract, free and
clear of all encumbrances, except for restrictions, reservations and
easements of record.
And said Grantors, for themselves, their heirs, executors,
administrators and assigns do covenant never to cut, damage, destroy
or remove any tree oc shcub or other natural growth uoon the
hereinbefore described premises for the continuance of this easement
and do hereby grant and convey to the said Grantees all grasses,
shrubs, trees and natural growth now existing on said lands or that
may be hereafter planted or grown thereon.
IN WITNESS WHEREOF, said Grantors have hereunto set their hands
and seals the day and year first above written.
?
David JJ??J? f - --
. K nedy ?
U
4 ?
Caroline A. B. Kennedy
i +
STATE OF MINNESOTA)
Nc?nep,.? ss.
?
COUNTY OE DAK?'?A-
On this 'jday of Q0UE'n3E.lZ , 1? $;5before me,
Public within and for said County, per? o a?y appeared
KSNNEDY and CAROLINE A.B. KENNEDY, husban n Wife,
be the persons described in, and who? xiuted
instrument, and acknowledged that they executed the
free act and deed.
?
THIS DOCUMENT DRAFTED BY:
••„'. 5
D. GRpENEINOLD
?';?;^9F M
::
N
ss?unnnpiro; J91.9]
w
HAUGE, EIDE & KELLER, P,A.
1260 Yankee Doodle Road, #200
Town Centre Professional Bldg.
Eagan, MN 55123
(612) 456-9000
to me
the
same
a Notary
DAVID J.
known to
foregoing
as their
Notary Public
0
6
scn!
LEGAL DESCRIPTION:
PARCEL 'A'
rn,i wt _f Lor s, zermen acKs. ora. ce.,r, wm<.ot.. iyMV -"n eI tm.w
PARCEL 'B'
iM sauln Oa 00 e..t ot LoT 5, iEHOEP AeflES, onet. eounly, tirvvwka
SuLpc? 10 Ml??em?nl lq vp??? ePe?? purpof.. OYM \M .N, 90001..L
?
Q
Ox
{o
O
Z
Y
H
O
J
?
? ?v
a
„?•,? „-E ?
" LONE OAK ROAD
- ' 1100t'
'? ?y• S[v°fSbCY )L14Y] r-••
1 ?
5[ GM 41 ?
<I[ ??/??:
O: ll^ .A m+S
.m v.a o oe •oi Y
CONSVlTINO EN6INEE?S. ,
,E PIPNMtPi o.a LwNo SVIIVEYOPS ...? ??;.. ?•? :s?R???a?? CERTIFICA`TE OF SURVE
.o,
NEEAING
,.
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 1425 Lone Oak Rd
Lot: 000 Block: 000
PID:10- 88800 - 051 -00
Use:
Description:
Sub Type: e- Fireplace
Work Type: Gas Insert
Description:
Census Code: 434 - Occupancy:
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Fireside Hearth & Home
20802 Kensington Blvd
Lakeville MN 55044
(952) 985 -6675
Addition: Zehnder Acres
Chimney /flue must be inspected prior to concealing. Smoke detectors are required in all sleeping rooms prior to final
inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required. Battery operated types are
acceptable if the wall/ceiling finish (i.e. sheetrock) has to be removed to install a smoke detector.
Andrew Hoffman
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Total: $90.00
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
Construction Type:
Owner:
Daniel R Darrow
1425 Lone Oak Rd
Eagan MN 55121
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$88.50 0801.4085
$1.50 9001.2195
Issued By: Signature
Building
EA081158
11/19/2007
ePermit
úü
ÿþ
þýý üûûú
ùýý ÿúíòè
ï
äää
þýö
ýüûúùø÷ö
õ
üúùø
÷
÷ö
õ
ôöõóøò
ñü
ü
ðìüøù
ïÿ
ýîü
òø
ëò
ò
îü
ò
û
ò
êé
ÿööøÿ
þé
é
òÿ
ý
øêé
é
øé
ê
ûòè
îü
ûùö
ÿéòùò
ê
íæðåæääêäêä
õù
ýü
æêãêã
çüðþê
ôó
öòñ
øø
óö
ùÜñ
ãüùó÷
ìó
ó
ë
ôð ÿ
ô
àâßâ
ûùöÿë
øø
é
ò
ÿ
òøùöøøûý
é
ýü
ùé ÿì
ê
øøõ
òýÿü
üùýÿü
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA137963
Date Issued:08/01/2016
Permit Category:ePermit
Site Address: 1425 Lone Oak Rd
Lot:000 Block: 000 Addition: Zehnder Acres
PID:10-88800-00-051
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Leilani Rodriquez-ruiz
1425 Lone Oak Rd
Eagan MN 55121
(651) 387-2931
Turnkey Restoration
12767 73rd Ave N
Maple Grove MN 55369
(612) 405-8876
Applicant/Permitee: Signature Issued By: Signature
41°
City of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink _
For Office Use
Permit#: / G
Permit Feer /‘) 5
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
Resident/
O ►ner �# `t
Name: 2_ e ,` l Q k/C 2_0 ,, ✓<: Ge C Z Phone:
1 ) /
Address / City / Zip: / G% 5 LG o c fl c, / ( ) c(
Applicant is: Owner Contractor
Description of work: _20 C)5- )6"p )c -e CC WC" it 2
Construction Cost: ,,, Cf, OOQ c-= Multi -Family Building: (Yes / No )
. n
Contraet�r
Company: G-GeT,`C V'Ye' Z CO P7 IL-ru C t.UhContact: _TC.)nGzhG)7 C7UG.'Y! i
L r', G'I 2 r& c% U `C'
Address: �� �/ � a � City: LP�OC�� u�'J�
�
/� /�' 1
State:/"? /U Zip: 5 57 2 �JPhone: lo5/ `:/ 8 Email:
License #: 2_j C Z ` Lead Certificate #:
If the project is exempt from lead certification, please explain why:
In the last 12 months,
Yes No
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
Phone:
NOTE: Plans and supports g document tat you submit are considered to be p blic in ns of
the information nay beiclassified as not -public if you provide specific reason at • p r the y to
conc`l "that they theY,ArairoatkAfOrets. ..
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.gorherstateonecall.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 Buildin• Code must be completed within 180
days of permit issuance.
x ,v pct u z eY Yc z x
Applicant's Printed Name Applican
Page 1 of 3