1590 McCarthy RdINSPECTION RECORD C°"tr°' "°. 362 CITY OF EAGAN PERMIT TYPE: k'?? ????NU
3830 Pilot Knob Road Permit Number: **1 "09
Eagan, Minnesota 55123 Date Issued: 1°' /04/92
(612) 681-4675
SITE ADDRESS: APPLICANT:
1698 MCCARTHY f7MGP- +:i I t r•75i1E'N [;O
11r..c:Ak'CHY Rp (61?) 646-1311*
F,
. . . . .. " ? . . . , - , . _ - ... - . . :-
I?..`___--_' __ _ _ --- .. . . . _,.., , . . .
-_--_ _.__-______.____-__ ?
PERMIT SUBTYPE: TYPE OF WORK:
?i t t?n??c:,.> REEwnas
CyESCRY'P1'IUM Rf.•-itVOF
?
ParmR No. Permit Hoider Dete Telephone i
SNV
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspectlon Date Inap. Comments
FooUngsl
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Flreplace
Final Htg.
Orsat Test
Fnal Plbg. Plbg. Inspector- Notity Plumber
Const. Meter
Engr./Plan
Bldg. Fnal
Deck Ftg.
Deck Final
Well
Pr. Oisp.
CITY OF EAGAN Remarks
Addition MCCaT'tRl-de
Owner Street ?
00
21
Improvement Date ? Amount Annual Years Payment Receipt Date
STREET SURF. 1976 1101.60 11o, 1() lo
STREET RESTOR.
GRADING
SAN SEW TRUNK ?f 1 8 100.00 0 Paid
# SEWER LATERAL 197 3711, 0 1 7, 2 1
* Sew W
WATERMAIN
# WATER LATERAL F97 15
WATER AREA 344 1977 160-00 10.66 15
STORM SEW TRK
STORM SEW I.AT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
9UILDING PER. 44?
SAC Lb
PARK
CITY of EAGAN
BUILDING PERMIT
Owner Kvebe.r? ..............
Address (Precent) ......................................................
,
Burton Development Co.
Suilder ........................................................................
,
Addrese ....... 124,01 A.l.I.eXI...J2?F :.......?Il.?'.n.?.3?.i.]..1?........
DESCRIPTION
N°_ 4109
3795 Pi1o! Knob Road
Eagan, Minnesoia 55122
459•8100
Date .......10/8/7..6 .....................
To Se Ueed For Fron! Deplh Heigh! Est. Cos! Perml! Fee Aemerks
7
I 125.5 ?
S/F Dwlg & Gar 58' 48' 44,000 Zz,0 0 s/c
LOCATION
S2rea2, Road or olher Description of Location Lo! Block Addition or Trae!
1590 McCarthy Rd. 3- 1^ I McCarty Ridge -
This permit does aot authorize the use of alreets, roads. I alleys or sidewalks aor does iY give the ownes or his agent
the right fo ereale anp situaiion whieh is a nuisanee or which prasenla a hasard !o the health, safety, eonveaience aad
geaeral welfare 3o anyone in the communi3y.
THIS PERMIT MUST BE KEPT ON THE PREMI3E WHILE THE WORI{ IS IN PROGRESS.
This ia !o certifp, ihat...$urton Cons.t ...........................has permisaion !o ereci a.......5/._.E ... ... Dwl ? G a r ............ .._
........
poa
---- ..............g ._.. ....• _ u
the above described premise subject to tpe provisions of alI applicable Ordinances for the CiYp ot gaa.
. ? ?
----------------- -- --?:.._?. :?....: Mayor ..--- ---...........----- • -----------............ .--------..........
Building Irupecto _
--------------- Per ? i.e._:........
. i
?o e?ity Ave., REm. S-1ce5t.Paul, MN55104?
I?II II III II III IIIII IIIII IIIII ?IIII I) (II IIIII IIIII BE Fl A ' P T O
* 0 3 3 3 0 9 2 6* Phone (612) 642-0800 9?y?yo
Home Duplex Apt. Bldg. , Other: New Addn
Commercial Indushial Farm Remod Re air
Air Cond. Htg. Equip. Water HM. Load Mgmt. Ofher:
D er Ran e Elec. Heat Tem . Service
'k' above the work covered by fhis request. Enter remarks in this space and on the back of the white copy only.
recunnect furnace a/c
Calculate Inspection Fee - This Inspection Request will not be accepted without ihe correct fee:
Other Fee # Service EnMance Size Fee # Grcuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./iraHic Sig. Above 200 Amps 100 Amps
Transformer/Generator INSPECTOR'SUSEO oy? TOTAL
$ign/Outline LTg. Xfmr. 820.50
Alarm/Remote Control C
wimming Poo
I h certi Iliat l ins e adsscribed herein on Me dates sWfed
e
Z-2
Iffi9pfion Boom E
Rough- Dale
Special Inspedion
lovestigative Pee
Final
THIS INSTALLATION MAY BE OR RED CONNEC IF NOT COMPLETED WITHIN 1 M NTHS.
?
3 3 3_0 V Z OFFIC USE O V This requesf void 18 monihs fmm volidatian dote pnnted in this 6
°/ v96+" 5 9
PLEASE PRINT OR TYPE
Requesl Dale Rough-in inspedion required2 ? Yes 42 No Ins 'on OtherThan Rough-ln:f] Ready Now ? Will Call
9/ 12 / 9 6 (You must wll ihe inspMOr when ready) oa,e ReadY: g 12/ 96
I, Q licensed contractor 0 owner hereby request inspedion of the a6ove electrical work at:
Job Address ($freel, Box, or Raule No.) City Zip Cade
1590 McCarthy Rd. ?, Eagan
I
Sedion No.
Township Name or No.
Ronge Na
Fire
Na.
Cuanty .
I I Dakota
Occupont Phane No.
Neil Kueber 454-4007
Power $opplier Addrees
ElecAiml Conkactur (Company Name) Contracbr Licensa No. Moekr Lic. No. (Plant Eleci. Only)
Joos Electric Co. CA 00961
Mailing Address (Conlmdor or Owner Pedorming Insbllation)
3980 * 95122
AulFiorized $ignature (Cantmdor ar Owner Performiig Imtallation
Phone No.
688-6280
1
EB-00001A.10 6/95 STATEBOARDCOPY-SEESTRYOION30NBACKOFVELLOWCOPY
ACli`Y OF EAGAN PERMIT
3830 Pilot Knoh Road PERMIT TYPE:
Permit Number:
Eagan, Minnesota 55123
(612) 681-4675 Date Issued:
Control No. 1362
BUTl.p7NG
0 0 1.8a 9
J.2/0 R jra2
SITE ADDRESS:
I ?) q0
L (] "i° : 3
lYi C; [:ART i-i '!
M CCA ,a, rFlv
8 L CJ C: K: a 0
R-tt- At*
[Y: u
DESCRIPTION:
RoF'
$ L31 I fi 5,;t1,y P E' ( f(I E:' S F ( hI 1,?J C, . 1
8 Cti ldWork Typp RE PRIR
?m;mm
REMARKS: ? o j ( q D (?
, i
} nndW' k ? 1
? ?+`e u? ..v ?? ? Y.?
FEE SUMMARY:
V A i._ U ,? ? 10 1?1 Y Q . c? ;,) rz?
Fc e
..?,
?7 ::.0 0
i'?t;ha 1- C7?? ?2 5 0
L :i C,. S E? a i" i:; i1
CONTRACTOR: - r? ?? pl. 3. cori"_ - sr o i.,). tQWNER:
Ci.itF+I",;:t=! C'I:l 6 13 c.?0 r3 01 17?6, k(JE8 rf>,G iVCIL.
f3??v1 i)r i(-, i i.lR AL't N! J.59 0
C: 0LM-. 1,; VAl-C. ?a[ 1' hl Id S, h A 2 r' FA f3 A lU lYl fd
? 6 l. .' 1 C IJ. b _- I 3 Q (:1 l,.J.. c: 1`4 ':y 11 .a (ij tl
?
I Etartby acknow;tezi?e th?ft;
anfo rmaticrn,i„w carr?;c,t anct
St'??tuto5 onrJ c-i ty
APPLICANT/P€FjbNTEE SIGNATURE
n-,vu '-reAd Chis app1%r..ationr q#jd s??tjo? tViat the
q,, ep ?ta 1fa.?}?1v ?i'th 617. app?'irabl ?w `?tat??r s?f I?n..
,
Y" fI i Y1 c'i tl c- P, , . ..... .:; . '?- . .` ' :
_.. - 1 . ._ ? .. ?
ISSUED Y: IGNAT RE
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
?
L ar: s 8 tCa(" 1"
1. 5 9 0 frf C C: 4 R T" I 1" f+. f7 G:1 E Ft i`; t fl ?` iJ
114i;cARrHY RO ? 6 :1;?j ss6 -13 0 0
?
?
Control No. 1362
?; lJ 1 !. ?J .C f?! L;
L"_'?t±t,1i9 f
?
-j
• . -? •-
PERM17 SUBTYPE: TYPE OF WORK:
":;"r (iViTa(., 1 I?:1::rFd1:F2
C)i.5;f:1? 7.p 71.C11V `r; i--FF00`r
PERMIT #
REACTIVATE
CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675
???IN
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, i copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of enerqy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date Oil Val uati on of work 1?t °X660, .
Site Address:1,5'90 ee
,?eem
STREET SUITE /
Tenant Name: (commercial only)
LOT BLOCR SUBD. {?
c L
D
? P.I.D. *
,
.
'1.?, ,
Descri tion of work: 910 -F 62 uS
The applicant is: [3 Owner ? Contractor ? Other (Describe)
Name Yl,t&,h GA2, ? NP i L Phoite
-11-5v-
Property ,
LAST FIRSi
Owner address _/5-'90
STREET
STE !
City `.1 ?.J State `2"J?iU Zip
Gpmpany CLe,tZ?SC r-) Phone 6-:,71l - /ZUO
Contractor Address 9/aO 17GG?fU/2 4Ve ?/O License # U o Exp.?7--y
City _(;D1dEA) V2 1('x/ , State Zip .SES-2127
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
5ewer & water licensed plumber . Processing time for
sewer 6 water permits is two days once area as een approved.
I hereby acknowledge that I hav rea
plicat ion and state that the information is
correct and agree to comply w all
tate of Minnesota Statutes and City of
W
Y
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
0 01 Foundation ? 06 Duplex ? 11 Apt./Lodging
0 02 SF Dwg. O 07 4-Plex 0 12 Multi. Misc.
? 03 SF Addition ? OS 8-Plex ? 13 Garage/Accessory
O 04 SF Porch ? 09 12-Plex ? 14 Fireplace
? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck
WORK TYPE
? 31 New ? 33 Alterations O 35 Tenant Finish
O 32 Addition ? 34 Repair O 36 Move
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Engineering
REGIUIRED INSPECTIONS
? Site
? Wallboard
,- ? -
?,.
r
?-
? lb Basement Finish
? 17 Swim Pool
? 18 Comm./Ind.
? 19 Corrnn./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
MWCC System
City Water
PRV Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Assessments
O Framing ? Insulation
O Draintile 0 Fireplace
s
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Nater Meter
Acct. Deposit
SJM Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Tra11s Ded.
Copies
Other
Total:
Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft, total
Footprint Sq. ft.
On-site well
On-site sewage
Buildirg
Variance
? Footing
? final
valuecim: $
,
SAC %
SAC Units
CITY USE ONLY
L ? BL
SUB .
RECEIPT
i
DATE: 64 ?- `
1996 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
New construction Add-on fumace ??
f?'??
? Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc.
Date: ? - //' / ?
FEES
?
?
Minimum Fee: Add-on/Remodel (existing residence only) $ 20.00
-------------
HVAC: 0-100 M BTU
Additional 50 M BTU
Gas Outlets (minimum of 1 required @$3.00 each)
State Surcharge
TOTAL
24.00
6.00
, ?p ?
?
SITE ADDRESS: 2
OWNER NAME:/IJ?/G A?.QC?2? PHONE #: -?'V-zt? ?
INSTALLER NAME:? A5e-
STREET
CITY:
PHONE #: ( L2
.l
CITY USE ONLY
L BL
SUBD.
1996 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? all commercial/industrial buildings.
? multi-family buildings when separate permits are = required
for each dwelling unit.
DA I t:
i:vhi i rii?C i r''i=ciCc:
WORK TYPE: NEW CONSTRUCTION
DESCRIPTION OF WORK:
FEES: ?$25.00 minimum fee Qr 1% of contract price, whichever is greater.
? Processed piping - $25.00
? State surcharge of $.50 per $1,000 of permit fee due on all permits.
CONTRACT PRICE x 1%
PROCESSED PIPING
STATE SURCHARGE
TOTAL
SI I E AUUKtSS:
OWNER NAME:
TENANT NAME: (IMPROVEMENTS ONLY)
INSTALLER:.
ADDRESS: _
CITY:
PHONE #:
SIGNATURE:
RECEIPT #:
DATE:
INTERIOR IMPROVEMENT
TELEPHONE #:
STATE: ZIP:
SIGNATURE OF PERMITTEE CITY INSPECTOR
.41oq
Date:
BUILAIS7G PERMi`I' t+F'2L%CATTON
l c? •-??J
LOT ? BLCCK ADD=^IOA1 ---
PARCFL & S£CTIO£I PNMBER IF UiVPLATTED /l) W77171) D?t3 D On
ADDP.FS5 OF PAR
7,03v IS3G9 /
E: TrLNIATEn eoss
ADDP.ESS
r---?
TEI.EPHC?NE iao .
-?-'-
COPITRACTOR& =4?? ?y )(? ?'FELEFHOIM' 00. ?L:)z
AnDxESS ?9CY
Note?. Include site plan, buildinq plans, and enerc?y calculations UT7.tY1 t.Y17LS
application
J ?
Signed
O£FICE iJSE
?
VALUtTIdTi ~-
SAC
B)ATE2 C011VEC1IQli
FaATER iIETEx
BUILLIING PERI4IT FEE
SURCHARGE FEE
PI,APJ CfMCIL FEE
PARK DEDICATIOSJ FEE
OTHER
TOT1;L*
e !i /a . /JC)
??1? D D
11+ ? .
APPP.OVALS :
ASSEuSME:?T CLERK ??. BUILDSNG DEPT. POLICE DEPT.
69A'%'ER & SM7ER DEPT. FIRE DEPT. pARK DEPT.
MASTER CARD
LoCATION 1590 McCarthy Road L3 B1 McCarthy Ridge
OWNER Kveberg
STRUCTURE AND
LAND LJSED AS S/F Dwlg & Gar
Permit
No.
Issued Issued To
Contractor Owner
eUILDWG 4109 10/8/76 Burton Dev. Co.
PLUMBING
CESSPOOI • SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING ' a //^, CFL
SANITARY SEWER I
OTHER
OTHER I
Items Approved
(Initial)
Date
Remarks
DisTance From Well
FOOTING ? SEPTIC
FOUNDATION CESSPOOL
FRAMING
? , TILE FIELD FT.
FINAL
ELECTiiICAL
HEATING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOI
DRAINFIELD
PLUMBING
WELL . jQ=_26
SANITARY SEWER
?
ViolaTions Noted
on Back
COMMENTS:
r
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO. DATE OF INSPECTIQN
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
a ACCEPTABtE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOILOWS:
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETIQN OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
REINSPECTION REVEALED
pATE OF REINSPECTION
CE RTI FICATION - I certify that I have carefully inspected the ahove in which I have no interest present or prospective, and that I have reported herein
all significant conditions oLserved to be at variance with ordinances of the Town of Eagan, epproved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
? ALL IMPROVEMENTS ACCEPTABtY COMPLETED
BUILDING INSPECTOR
COMMENTS:
DATE
23
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_ua r ?
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VILLAGE OF EAGAN WATER SERVICE PERMIT
1795 Pilot` Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
I agree to comply with the Village of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By Date Paid:
Date of Insp.: j/- / r ., (/
Insp.:
VILLAGE OF EAGAN SEWER SERVICE PERMIT
3795 Piiotknob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
1 agree to comply with the Village of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
B y : Misc. Charges:
Date of Insp.•
/l s - y � Total:
Insp.: / / Date Paid:
Clly of Eaaali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5676
Fax: (651) 675-5694
Date: Co— / 3- / 3
Use BLUE or BLACK Ink
For Office Use
%r
Permit: 1
Permit Fee:
Date Received: fj /1 11 13
Staff.
INFLOW & I FILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Tenant:
Site Address:
Name: /(ie,i I
Address / City / Zip:
/ 5-90 /11 � Ca ,/-k h y lfti
Suite #:
/S'90 /11 C C a /i
Name: }- S i °i P i"p, b t » se License#:
Address: o i a City: Z
Phone: (, - I (o
Contact: , Email: m K C' -e J.
2.
PLUMBING (Within the building envelope)
// Sump Pump Repair
Other.
SEWER & WATER (Outside the budding envelope)
Repair
Other
Description of work: PQ p) p
FEES
$60.00 / Each (includes $5.00 State Surcharge)
TOTAL FEE $ (ssa ' U C/
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 111 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeallan.com/inflow., or City Hall at 3830 Pilot Knob Rd.
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.00pherstateonecall 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.
x
Appllcant's Printed Name
"L.
Applicant's Signature
Use BLUE or BLACK ink
---------�
� For Office Use
� i
��� O{'��} �n I Permit#. �Q � I
� 1 (t� !1 / �
3830 Pilot Knob Road R�C�IVED � Permit Fee: `C.-�� �
Eagan MN 55122 � �
Phone:(651)675-5675 �E(, Q 2 2��5 I Date Received: �
Fax:(651)675-5694 j �
� 5taff: �
2015 MECHANICAL PERMIT APPLICATION
❑ Piease submit tuvo(2)sets of plans with all commercial applications.
1 / p ,�'� _ 1
Date: d►� Site Address• '�l d ���0��1'u0 6�6'l.
Tenant: Suite#:
Name: �� Phone:��(�ilJ'"l �l_.�J!��
Resident/Owner
' Address/City I Zip:
Name: ~ License#: P (
C011tt'aCtOt' Address: N City: �
State:�_Zip: �� Phone: (Sf"� �/"/ � ����
- � —
Contact: � Email: `C.G�
New Replacement Additional Alteration Demolition
Type of Work Description of work:
N(?T�:Roaf mountetl and ground mounted mechanical equipment'is r�quirsed to be screened by Gity
Gade. Please contact#he Mechanical lnspectar for informatian cn permi#t�d screening;metttods�
RESIDENTIAt COMMERCIAL
V Furnace New Construction _Interior Improvement
1��Ct1"tlt T�/p@ —Air Conditioner _Install Piping _Processed
Air F�cchanger Gas Exterior HVAC Unit
_Heat Pump UnderlAbove ground Tank (_Install/ Remove}
Other
RESIDENTlAL FEES
$60.00 Minimum Add or alteration to an existing unit,includes State Surcharge �l
$100.00 Residential New,includes State Surcharge =$ �`�TOTAL FEE
COMMERCIAL FEES Contract Value$ x.01
$6Q.00 Permit Fee Minimum
$70.Q0 Underground tank installationlremoval =� Permit Fee
Surcharge=Contract Value x$0.0005 -$ Surcharge �I
If the project valuation is over$1 million,please call for Surcharge =$ TOTAL FEE
I hereby acknowledge that this information is complete and acxurate; 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 uvithou permifi at t work ' be in accordance
with the approved plan in the ase of work which requires a review and approval of plans. �,
C `,
X r o�
A p icant's Printed Name pplicant's Signature
FOR OFFICE USE
Required Inspections: Reviewed By: 1�ate:
Underground Rough In Air Test Gas Serv'rce Test` In-floor Heat Firtel FiUAG Screening
11,111
CityofEaQafl
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #: C'311 71 �
Permit Fee:
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 6 --2/- zeig Site Address: /S 0 G 77a # /%k £(
Name: A2 / O. "<i), -F60,2- Phone:
' n Address / City / Zip: /- ?Q ,� f /�--W
Applicant is: Owner X Contractor
Unit #:
Description of work:
Construction Cost:
Company:
Multi Family Building: (Yes / No K )
Contact: k4- Q`-1 t
Address: .3 o7 ®(A(LLUA-►v 3 c
City: `lam v v'v�S e,
State V'^lN% Zip: c,S�3 ( Phone: 6/2 :74'1'0 `'F' mail: Y°✓iK
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License #. �3l 6.3(0 Lead Certificate #:
If the project is exempt from lead certification, please explain why:
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:
Fire Suppression Contractor: Phone:
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.000herstateonecall.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.
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.
Applican Printed N
..e !«4z r, c
Appli ant's gnature
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