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2029 Flint Lane Use BLUE or BLACK Ink r For Office Use I 1 Per mit#: of Eajan iI ss ~V I Permit Fee; l I I 3830 Pilot Knob Road / I Eagan MN 55122 Date Received r~~ l Phone: (651) 675-5675 l I Fax: (651) 675-5694 `Staff: INFLOW & NFILTRATION PERMIT APPLICATION . Plumbing / Sewer & Water Date: Site Address: ~Tenant: Suite M RESIDENT OWNER Name: 0 ©h pi q e -~-e L\ T G ki Phone: & S J_ / Address/ City /Zip: ~ 4 Q /1_1- 'S ,T / Name: Rt~-_-,S iC ^ Pj cA"L_7a jog Sitfo, i(_1 I" CONTRACTOR Address: P f3. 8c --.4- t ? City: rl a~~y., State: vl~i N Zip: .5 . Q. Phone: (-Si- (.%1- 8, 2,S 2- Contact: M'# J(j e J 4z Email: 1'""t i ✓i ta he x,r a'Q„ 1 r+ r PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope) TYPE OF WORK Sump Pump Repair Repair Other: Other: DESCRIPTION Description of work: ) -~r'G i w 3 'r ' FEES $55.001 Each (includes $5.00 State Surcharge) TOTAL ~~E$ S -O • O 6 *Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs o reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.city2feagan.com/inflow, or City Halt at 3830 Pilot Knob Rd. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 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. x o/1s2 %C1i z v Applicant's Printed Name Aplilicant's OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground ,Rough-In -Final CITY OF EAGAN g169 3830 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55121 AJ? . PHON E: 454-8100 BUILDING PERMIT Ts M w.d fa. Iif R 0 UF Site Add? . Lot Percel No. _ W Name nViJLf\ 1 .71 L ? Address +`i City Phone A Name Addre ? City . Address City Phone Receipt # - 0 .lUBE 13 .84 Erect 0 Occupancy n ? 111ter 0 Zoning Repair ? Fi?e 2one Enlarfle p Type of Const. Move O # Stories Demolish ? Length Grode p Depth Sq. Ft. Approvab Fees ASSessmenf Woter & Sew. Police Fire Enp. Plonner Councll Permit -? Surchorge _ Plan check _ SAC Woter Conn. Water Meter Road Unit _ I hereby ackrowledge that I hove reod this opplicotion ond state thot gldg, pff. _ the inlormation is correct nnd ogree to comply with oll opplicoble ? State of Minnewto Statutes ond City of Eagon Ordinonces. APC Tofol Slynoture of Permittee '`. l-y, ? . A Building Permit fs issued *e: I?iL-Loor" ut ion?I_f ks on the express conditlon thai oll work shall be done in xcorda uft applicabfe ?$lafc Minnesota Statutes and City ot Eopan Ordinances. BuildinQ Offitiol ?ftfi ? Permit No. Pormit Haldsr Misc. Permit No. Holder Plumbing H.V.A.C. Wall Wster Disp. Sewsr Ekctrie I Inspection Date (nsp. Other Footings Foundation Framinp Rouph Plbp. Rough HVA Inwlation Fina1 Plby. Finel HVAC Final ? Waur Descrfbe Location: Wsll Sewer Pr. Disp. II I CITY OF EAGAN Remarks Cedar Grove Acquisition Addition Cedar Grove #3 Lot 21 aik 7 PeFcei 10 16702 210 07 Owner f? d>> Street 2029 F1.int Lane State Eagan,MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRAOING SAN SEW TRUNK # SEWER LATERAL 972 1304-00 . WATERMAI N # WATER LATERAL WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PAR K CITY OF EAGAN 3795 Pilot Knob Rood Eagon, Minnesota 55122 Phone: 454-8100 2%IC PERMIT No. 3434 Date: 5-21 ?' Receipt tvo.: 14144 20? ??? LWY-c, Single I Site Address: _ Residentiol ? Lot <71 L Block 7 Sub/$ecC i,J 3 _ Multi Res., Comm./Ind. Pr*ert Steffen5cm Nome New/Alter /Repair . ; Address ??? Flint Ia)e Cost of Installation O City Phone: Permit Fee ey Htg. £K A/C 0-'?'?.-w Vdl3 a! i . Name Surchorge ? 7 ? 170 Ogciz'r Ave. I;o" Address 4 c 0 r V City Phone: Total This Permit is issued on the express condition that all work sholl be done in accordance with nli oppiicobie Stote of Minnesota Statutes ond City of Eogan Ordinances. 64 / Buildirtg Officiol CITY OF EAGAN ?7 i 3830 Pilot Knoh Raad, P.O. Box 21•199, Eagan, MM 55121 1?1 ? 9169 PHONE: 454-8700 BUILDING PiRMIT T. 6e uud fe, REROOF Site Add??s . Lot L1 Parcel No. _ w Name O I L > Address ?Hrit ? City Phone "" """` "' o Name - Z u? Address-? M ?-- VL?o ? City Phone Name _ Address CitY _ Phone I hereby acknowledge that I hove read this opplication und state thot Ihe informotion is correct and agree to comply with oll applicnble $tote of Minrresoto Statutes and City of Eagon Ordirances. n ? . Signafure of Pertnittee -S_ A 8uilding Permit is issued to: oll work shnll be done in acm Building Official $1900 ReCeipt # / 103 7 Erect ? Occupancy n _.)_ Alter ? 2oning R1 _ Repoir ? Flre Zone Enlarge ? Type of Conn. Move ? # Stories Demolish ? Length_ + Grade ? Depth Sq. Ft.- Apvroralf Fees Assessmenf Permit D 79 llll Wuter & Sew. Surcharge . on Police Plan check Fire SAC Eng. Warer Conn. Plonner WaterMeter Council Rood lJnit Bldg. Off. APC Totol on Nre express cordition Ihar wfo Statutes and City of Eogun Ordmances. EAGAN TOWNSHIP N? 1144 BUILDING PERMIT Owner ..... L..Z'..s-s[%r/--h./?'t.?/:c_-.C.'d:xa.:..-? ................ Eagan Township Address (presenl) .,,444.., ...... .__...... ._. - Town Hall Builder ...... - --..----.. ........................ .._ _...... . ............... ...... .. Dale _ ......... .._..._.. . . .. ........ -.--.. ......._ _...?`...?.?.!.l!.??.._ --...... _._.. Address .............. ........ .._._ _ DESCRIPTION Sfories To Be Vsed For Fronf Depih - ? Heighl Esi. - Cosf Permii - Fea - Remarks _ - -?-- ? --?? -- -- - - -- - -- ?.- - I ? ?'Zl? ----- -- %?_ p - LOCATION?" -'" Sireei, Aoad or oiher Descripiion of LocaSion Lof Block Addifion or Tract ? St /±A 7 t?C _17? Le-4- 6A1 T+ 3 This pexmit does not authorue the use of sireels, roads, alleys or sidewalks nor does if give the owner or his ageni the righf fo create any siivation which is a nuisance or whiah presenis a hazard !o the heelth, safeiy, convenience and geaeral welfare !o anyone in the communiiy. THIS PERMIT MUST BE KEPT O THEPREMISE WHILE THE WOAK IS IN PROGGRESS. „ . This is So aertify, ihal.?i...-+f5.:..:?_.Cp.ra?,a... ......... has permission !o erecS a. _a..L?__ ?.d.^....'.7c-? pon the above described premise subject io the provisions of the Building Ordinance for Eagaa Yownship adopiedGApril 11, 1955. ?j ?.L ? Q/ J Q A .............. P .. . .. ..._...._..._ "..'."Y..?__..._. Per . ? -?.c_--O?!-'?:Sr._..K.?..... Chaifman ai Tnwn Board Buildin9 Ins eetor "7 CITY OF EAGAN BUILDING PER= APPLICATION 7v se vsed For valuation Yfl ?C}C i site Address: Q c-i -F- / r at L-Cl I't ? Int ? Block ?_ sec./sub. C'ed G-2L/? Parcel #: IO ." IIc 70 a-Lp - 0 7 Oaner: ?C??? a"'rt ?• ??'' ?-??? 11 _??? i? Pddress: .'?? ?]-- F f r /1 ? ?-Cl il "c City/Zip Code: 4.R c14 C-f •?) J 1 °Z Phone #: ? Contsactor: Aaaress: City/Zip Code: Phone # : Arch./Eng.: Address : Include 2 sets of plans, 1 Certificate pf Survey & 1 set of energy calculations. Date 6 7-5?q OFFICE USE ONLY EY'2cr oocupancy K- 3 Alter Zoninq Repair-= Fire Zone N /A Enlan7e Zype of Const. Move # Stories Derrolish Front ft. Grade Depth ft. APPRIJVALS FEES Assessments 00 Permit Water/Sewer Surcharge ? • - Police Plan Check - Fire SAC Eng. Water Conn. Planner Water.Meter Council Road Unit - Bldg. Off. APC - City/Zip Code: ? Phone #: Date: City of Eapll 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 22 f' 0 3 Site Address: Unit #: Resident!`. Owner Name: -4,-'-, .-‘ 5 4-, cL .-, s ,, ., Phone: Address / City / Zip: 2 c- :'L_ - Li . 4— L•N Applicant is: Owner ik, Contractor ��< ype of o - 4 ^ '€ ` mo i+ - Description of work: '� � Construction Cost: c' ' Multi -Family Building: (Yes / No ) Contrac or C Company: "` )-- (-12- =� Contact: L 1 J S{',----4-(0. v' � e v: 4 > (r., ..]� b) . TL_.. J t. _ t vim" 1. Address:City: State: �`� Zip: ' I Phone: License #: 1:S CC G"I"' `t `(I Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, Yes No If 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? yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: NOTE Plans;=and supporting documents that you submit are considered to be pub/19104.04tion Portions of the information may be classified as non public if you provide specific reasons that would permit the City to .. fl .. y :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.gopherstateonecall.orq 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. rior wor authorized y a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 ays,of perm t issuance x Applicant's Signature Page 1 of 3