1713 Monticello AveCITY OF EAGAN Ramarks Wtl" COYll]. i?d, on 9-19-72
Addition Cedar Grove #8 Lot 3 elk 6 Parcel 10 167Q7 03n 06
ow„e??jtul ). L.?vto?4-Fa-nm Street 1713 Monticello Ave. stete Eagan,rrnr 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK r?-•f 1970 125.00 ,oo 2
?f SEWER LATERAL r,.- y 1274 1539.10
WATERMAIN
WATER LATERAL 1974 5
WATER AREA
? STORM SEW TRK
# STORM SEW LAT 1274
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. OO OO 6456 -19-72
BUILDING PER.
sAC 260.00 6456 9- 9-7
PARK
1N SYl:U'1'lUN KLUUKl1
CITY OF EAGAN PERMiT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITEADDRESS: APPLICAMT:
i;; ;a I_! 0 AVF ? . . , ,.. .
? I 1?1tti (?l:l?V'i_ #1t i E,F, 1 3 4'.4 t,iltti
tst? 1 111 f ri,i
0 3
dI ti
PER??TWA7YPE: TYPE OF WORK:
?ii , t.: 1;• ! 1 iil.i I 1 jriit?f i`. i t??'i? I?r???}/??,1
Permit Holtler Date Te4ephone #
PLUMBING
HVAC
Inspection Date Inap. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIAEPZACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
9ECK FINAL
EAGAN TOWN S H I P
BUILDING PERMIT
,?+ .. .
Owner ........?s-?-'c.•. ?-? ..•.-
/--?.--•-••----•---...-.--.- .. ..
Address (Presenl) .....?x?.:.._?/...:•••v..:`."77??..................... ....
Builder ..........
Address ..._ ._.
DESCRIPTION
N° 2850
Eegan Township
Town Hall
Date 90. - ?` 1- 7 Z
.... ...........•-•....• .......................................
Sto:ies To Be Used Fo: Fron! Depih Heigh! Eel. Cos! Permi! Fee Rsmarlcs
7 z,C?'
This permit doss not aulhorise the use of strsels, roads, alleys or sidewalks nor does it give the owner or bis agon!
!he riqh! !o create anp siiualion whieh is a auisance or which presents a hazard !o the health, safetp, coavonionce and
goneral welfare to nnpone in the comrnuniip.
THIS PEAMIT MUST BE KEPT ON E PREMISE WHILE THE WOAK IS IN PAOGRES .
..This ia !o cerlify, !hal...L.r..t.rr?:R::?-:••.t... ?'r.-?- .?ias permissioa !o ereet a•-•7 ..... ..........`-•- :?--•.`.:'c,^,':'?'?.._upon
!he above described premise subjeet io the provisions o! the Buildinq Ordinance foi Ea9 p dopl?d an T wn:hi a
]?pril 11,
1955.
.. ........ .. • ••••••. ..................
............... ....... . .x.? --------------------- ........ pe= ............... ....... jp
•••-••.............._................
Chairmaa oi Tnwn Board Buildinp Inap?ctor
`s 75
3-4p -fr
c: !?.
?
T01'I4 0; EAGAI?
3795 Pilnt Kuob ;:oid
Eagan, Ninneaota 55121
PERMIT N0. 254
The Roard of Scpervisors hereby g:ants to Cedar Grove Construc:larl Co.
of 73113 Ccaicord 31vd. E., 3outli St. Paul $5075
a liEATLiG Permit ior: (Owner) same
10 C4irnelign ?1 3-71 . tlislt Garnel.ian 2-7. 1862 Jade -5-79 3982 iiiverton 6-5-8.
ae 1713 McsltiCe.ffb,'35'38 hlackhawk C. 10-9*rsuant to application dated
1738 3arte1l 16-10-8 -
9/1 "/72
Rae Paid: 1.10.[1C Dated this 79*..h day of Sentemher , 19-7z.
3.5U s/c '
BuiZding Inspector
C c; .
TOlN OF EAGAId
3705 Pilot Iusob.iioad
Eagan, 2iinneaota 55121
PEU1IT N0, ?62
.
The Board of Supervisor3 hereby g.ants to Catlar Grave Constxuction Co.
af 2343 Concord Blvd East 9outh 3t Paul 55075
a PL??M3I?+?3 Pexmit for: (Owner) eame
vert?-5-5?-
fl c/'?-? - '- 2 ??j- ? l??=T ? 3992-Ri ,
?171?°"*i `?8ant to application dated
Fee Paid: •10 00 Dated this 19Gh day oF Sep?ember
3.50 s/a
Building Inspector
??
310 s???, 1
PLEASE PRINT OR TYPE OFFlCE USE NLV This reqoesr roid 78 moniFs hom wlidanon dak pnnkd in Mix box.
&/970
Reqvgs? Do
?O /'' / 9 Rwgh-in inspMion requirtdY ? Yes
(You mo?l wll the imPector whm readrl inxpectian Olher Than Rovgh-?e;,?.0.eatlyYJOw ? Will Coll
Oale Reody:
I icensed conirador ? owner hereby request inspedion of Poe a6ove eletlriml wark af:
Job Pddmas (SVeep Box, or Rouk No.) Ciry Zip Code
Sedlon Na. Townahip Name or No. Range No. Frt o. Cowry
Ocap
? Phone No. 7/
? J V
P uppliar Pddmss
Elecln onnacbr JC pony N e)
G Conhatlor ii<enae Na. Maskr lic. Nn (Plant Elee. Only)
Motlin Addresz (Comrador or rming InsMllolion? !
( Yl/
onxad Sign ure? or O rPeRorming Insbllalion)
/?p???? - ' Phag?ar-
/?J/
EB-00001h10 6/95_? STATEBOAHDCOPY-SEEIN5T11UCTIONSONBACKOFYELLOWCOPY,.____1fj
IIII I A1111*11 RE QUEST FOR ELECTRICAL INSPECTION ?? 9
? ? e?
Minnesota State Board of Electricity
?a .>
1821 University Ave., flm. 128 StPaulMN 55104 ?
* 0 3 i, Il 6 9 Ph o n e(612) s a 2-0te o o G???' j( P
ome Duplex Apt. Bldg- er: New Addn
mmercial
Indushial
Farm
Remod
Re oir
1
Air Cond. Hfg. Equip. Water Fkr. Load Mgmf. Olher.
D er Ran e Elec. Heat Tem . Service
"X" above ibe work mvered by fhis requesG EMer remarks in Mis space and on }he bock of the white copy anly.
Calculate Inspecfion Fee - This Inspection Request will not be accepted without the correct fee:
Olher Fee #t Serrice EMmnce Size Fee # Cirwils/Feeders Fee
Mobile Home Park Stoll 0 fo 200 Amps 0 to 100 Amps
Streef Ltg./Traffi< Sig. Above 200 Amps Above 0 Amps
Trans{olmef/Geneta}or INSPECTOP'SUSEONLY TOT
?
$ign/Outline Lfg. Xfmr. ?D ?
Alarm/Remo}e Coniral
$wimming Pool I hercb can that I ?nz «ied ?he elednml innallafion dssmbed h<rcin on Ihe daks zmkd
Irrigdtian Boom Ra,h-ln Date
S
ecial Ins
edion
p
p
Inves}igative Fee Final Dob ?
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 ONTHS.
MASTER CARD
Permit
No.
Issued Issued To
Contractor Owner
BUILDING ?
PLUMBING Z6 ?j
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING 'Ar
1/
GAS INSTALLING _
-
SANITARY SEWER .
OTHER /11/7
9sq
?
OTHER I
Items Approved
(Initial)
Dafe
Remarks
Distan[e From Well
FOOTWG Z!2 A- 7 SEPTIC
FOUNDA710N ? CESSGOOL
FRAMING TILE FIELD FT.
FINAL
ELECTRICAL
HEATING
i
i?0 • - /
Y DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING ? ?v - y ? D • ??
WELL
SANITARY SEWER
??
f
-
-
d?---- I ` 7 -3 . .
/
Violations Noted
on Back
COMMENTS:
OWNER
STRUCTURE AND ?
LAND USED AS
COMPLIANCE INSPECTION REPORTS
TO 8E USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO.
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
DATE OF INSPECTION
? ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOLLOWS:
11 NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
REINSPECTION REVEALED
DATE OF REINSPERION
CE RTI FICATION -1 certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein
all significant conditions otserved to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspectQd.
17 AlL IMPROVEMENTS ACCEPTABLY COMPLETED
BUILDING INSPECTOR DATE
NTS:
..?r:, ? ?
EAGEsN TOWNSHIP
3795 Pilot Knob Rosd
St. Paul, Minnesota 55111
Telephone 454-5242
PERtaT FOR WATER SL+RVICE CONNECTION
Date: Number: gag
A
Billing Name. Site Address: o?-
Owtter: ?/?'?(`Q Billing Addreas
????? •
Siae
9/19/72
Connection
Meter No. ?Permit Fee 10.00 9119172
Meter Reading Meter Dep. .o pd 9 19/72
Meter Sealed: Yes_ IAdd'l Chg.
NO I 1bta1 Chg.
Buildiag is a:
Residence xx
12ultiple Ho. Units
Commercial
Industrial
Other
Inspected by
Date
Remarkg;
$?.5.00 RE-INSFECTION fEE fOR
IMPROPERLY INSTALLED METERS.
By:
Chief Iaspeetor
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do tte proposed work in accordance with the rules aud
regulatioas of Eagan Township, Dakota County ;innesota*
BY:
Please notify the above office when ready for inepection and connection.
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454•5242
3-6-Y
PERMIT FOR SEJER SERVICE CONNECTION
DATE: q I?? NUMAER 1147
OWNER• Address
PLUMBER 0.? TYPE OF PIPE
DESCRIPTIEIN OF BUIIDING
Industrial) CoffinercialI Residential Multiple Dwelliag No, of units
Location of Connections:
Connection Charge 260.00Pd 9/19/72
Permit Fee 10.09 pd 9/19/72
.50 Pd 9119172
Street Repairs.
Total
Inspected by:
Date
Remarks:
By
Chief Inspector
In consideration of the issue acd delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Toc-inship, Dakota County, Minae t
B
Please notify when ready for_inspection and connection and hefore any portion
of the work is covered.
LC3- BL & CITY USE ONLY RECEIPT #:
SUBD. _? ? DATE' ? / 7
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
? Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc.
?
Date:
FFFC
• Minimum Fee: Add-on/Remodel (existing residence only) $20.00
? HVAC: 0-100 M BTU 24.00
Additional 50 M BTU 6.00
? Gas Outlets (minimum of 1 required @$3.00 each)
? State Surcharge .50
TOTAL
SITE
OWNER NAME: UH"ll 111°1,91J Q PHONE #:
INSTALLER NAME:_ preferred heating & air I
STREET ADDRES$:: 7643 Logan Avenue South
I Richfield, MN 55423 ,
CITY_ Bus:866-7611 Fax:866-0125 ZIp:
?- --- ?
PHONE #: (
)
1
7/
CITY USE ONLY
L BL
SUBD.
-O;.,
RECEIPT #:
DATE:
,
1996 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for. ? all commercialfindustrial buildings.
? multi-famity buildings when separate permits are nQl requiredfor each dwelling unit. ;
,
DATE:
WORK TYPE: NEW CONSTRUCTION
CONTRACT PRICE:
DESCRIPTION OF WORK:
INTERIOR IMPROVEMENT
FEES: ?$25.D0 min(mum fee ,QL 1% of cornract price, whichever is greater.
• Processed piping - $25.00
• State surcharge of $.50 per $1,000 of Romt fee due on all permits.
CONTRAGT PRICE x 1%
PROCESSED PIPING
STATE SURCHARGE
TOTAL
cirP: nnnRFgG; ----
OWNER NAME:
TENANT NAME: (IMPROVEMENTS ONLI)
INSTALLER:
TELEPHONE #:
ADDRESS:
CITY: STATE: ZIP•
? PHONE
.
.
SIGNATURE:
SIGNATURE OF PERMITTEE CITY INSPECTOR II
I
FERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMITTYPE: BurL°ING
Permit Num6er: 0 3 2 9 4 6
Datelssued: 08t1$/98
SITE ADDRESS:
P.Z.N.a 10-16707-036-06
1713 MONTICELID AVE
LOTs 3 BLOCKa 6
CEDAR GROVE #S
DESCRIPTION: aEROOF/sroRM DAMA6E
YP
Bu,j?=1?C['"q?Permit Type STORM DNMAGE
??`?fd??.Ytg ?tRxC k Tqpe REPAIR
434 AIT. REStDENTIAL
?aff aQ? v ?'iaa? {W
REMARKS:
FEE SUMMARY:
CONTRACTOR:
APPLICANT/PERMITEE SIGNATURE
A ??p - HppllcanL -
[?WATT? -Y J O H N
1713 MONTICELLO AVE
EAGflN MN 55122
(651)454-5071
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOBRD - 55122
681-"75
New Construetion Requirements RamodeUReoair Reauirements
? 3 registered site surveys . ? 2 copies of plan
? 2 copies oi plans (inUude beam 8 wfndaw sizes; pouretl (nd. design; etc) ? 2 aite surveys (exterior addkians & dedcs) `? 1 energy calculations ? t energy ralwlations for heated additions
? 3 copies of trae preserva6on plan if lot platted aRer 711193
required: _ Ves ! No d C)
DATE: CONSTRUCTION COST;
ST??
DESCRIP OF WORK: ?Qe/k A-r lefJ.s7/I S
STREETADDRESS: / 7/.3 ,/24,,VL /?
LOT: 3 BLOCK: (2 SUBD./P.I.D. #: ?Ar, G ?0 \j
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
Name:. Phane #: ? /- ?j?/`SZ) 7Z
Lass Firsc '
Street Address: /'7c? t? l i7 e±-LE
City ys¢-,-?i /y State: o01-1 Zip:
Company: Phane #:
Street Address: License i1
City
Company:
Name:_
Street Adc
City _
State: Zip:
Phone
Registration #: ,
State:
Zip:
Sewer & water licensed plumber (new construction only): . Penalty applies when address chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this applicaGon and state that the information is correct and agree to comply with atl applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of
OFFICE USE ONLY
Certificates of Survey Received _ Yes _
Tree Preservation Plan Received - Yes -
OFFICE USE ONLY '
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
D 02 SF Dwelling p 07 4-plex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 _-plex
WORK TYPE
? 31 New O 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
? 11 Apt./Lodging ? 16 Basement Finish
? 12 Multi RepaidRem. IJ 17 5wim Pooi
O 13 Garage/Accessory ? 20 Public Facility
? 14 Fireplace ? 21 Miscellaneous
? 15 Deck
? 36 Move '
? 37 Demolition
Basement sq. ft. MC/WS System
_ Main level sq. ft. City Water
_ sq. ft. Fire Sprinklered
_ sq. ft. PRV
_ sq. ft. Booster Pump '
_ sq. ft. Census Code. '
_ Footprint sq. ft. SAC Code
Census Bldg
Census Unit
Buiiding Engineering Variance °
Permit Fee Valuation: $ '
Surcharge
Plan Review '
License '
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PL
Park Ded.
Trails Ded.
Other
Copies
TotaL•
% SAC
SAC Units ?
? PERMIT#
RECEIPT DATE:
MIDEPTtAL PLUM$1N6 PERMTf Af'P11CATlON
crrYoF FAsm
ssso Paor Kvos sn
EA6euv. nt1Q 55122
657-6$I-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for irrigation system
SITEADDRESS: I -7 I -?) , • ? f-- \
rv-\?
OWNER NAME: : TELEP,HONE #: v.7 I tfn
(AREACODE)^
INSTALLER NAME: TELEPHONE #: ?J ? ,+- l0
n? - (AREA ODE)
STREET AGuRtSS:
CITY: STATE: ZIP:
Place a check mark next to the uermit work tvoe
Ptew residential dwelling unit under construction and not owner/occupied $ 90.00
r/ Add-on, modification or alteration to existina dwelling unit, including: $ 50.00
• abandonment of septic system
• new installation/repair/rebuild of RPZ
• lawn irrigation system
• water turnaround
Nature of work:
Septic System, new/refuroished - $ 225A0
• includes County & Consulting Inspector fees
• requires MPC license
State Surcharge $ 50
Total $
r) r? - -?'r -
Reminder.• Be sure to schedule inspections of alterations, i.e. water heaters, water
I herebyacknowledge that I have read this application, state that the information is correct, and agree to complywith
is ihe applicanPs responsibiliry to noti(y the property owner that the City of Eagan assumes no lia6ility for any dame
operational and maintenance activities to the facilities constructed under this perrnit w" Ci"ro,;erty?ght-of-w;
SIGNATURE OF PERMITTEE
•s, etc. u v ?I
i
by the City during i{s rmal
?
Updated 1101
MECHANICAL (RESIDENTIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: Single Famity Dwellings Townhomes and Condos when pemvts are required for each unit
Datea /Q\A /Q3
Site Address -Z e \\Q klllle- IInit #
Property Owner `(,?S ` Q, Telephone # ( ?0 S\)
C ss a
Contractor ?r
Street Address City ?Q oP? v
?^?Zip Telephone#
The Applicant is _ Owner ` Contractor _ Other
Add-on, modi6cation or alteration to esisting dwelling unit ? 30.00
V furnace replacement
air exchanger
air conditioner
- "
?
OlhBf
State Surcharge $ .JQ
Totai $ 3 fl, s?
I hereby apply for a Residen[ial Mechanical Pemvt and acknowledge that the information is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a
permit, but only an appGcation fot a pernut, 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. C\ N
\ \/ ?
- h 0.t?O?o SV? V
ApplicanYs Printed Name -? ApplicanYs Signa
MECHANICAL (COMMERCIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for. commerciaUindustrial buildings
multi-family 6uildings when sepazate pemvts are not required for each dwelling unit
Date
Site Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Telephone # ( ) " °
Contractor
Street Address City
State Zip Telephone # ( )
The Applicant is _ Owner _ Contractor _ Other
Work Type
_ New construction Underground Tank _Install _Remove '
Interior Improvement Call for inspection during installationlremoval of tank
Processed Piping
Nature of Work:
Permit Fee $50.50 Mlnimum Fee (includes State Sumharge)
ConuactValue $ x .Ol% _ $ PemutFee
• If permit fee is $1,000 or less, add $.50 => $ State Surcharge
If permit fee is over $1,000, add $.50 per
$1,000 Permit Fee
$ Total Fee
I hereby apply for a Couunercial Mechanical Permit and acknowledge that the information is complete and accurate; that the work
will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand tlris is
not a permit, but only an application for a permit, and work is not to start without a pemut; that fhe work will he in accordance with
the approved plan in the case of work which requues a review and approval of plans.
Applicant's Printed Name
ApplicanYs Signature
Approved By: , Inspector Date:
Use BLUE or BLACK Ink
r-------------------,
I For Office Use
City Ol 1rJnaEdPermit I Permit Fee: _D5
I
3830 Pilot Knob Road q ' 1
Eagan MN 55122 I Date Received: b 1
Phone: (651) 675-5675 I 1
Fax: (651) 675-5694 I Staff: 1
I 1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION j
Date:5eP-'' ka1"Lot_5 Site Address: Unit#:
Name: e• Phone:
Resident/ 1-71' M
M `
( Owner Address / City / Zip: o rn c.,. v t, 'a ascr a-►- N
a
Applicant is: Owner „Contractor
4-
T Of Work Description of work: ~C_Im ► fie_ Zcxs
Type
rr
Construction Cost: to C) 5 Cd • ~s Multi-Family Building: (Yes / No
Company: h~C a c~~ikr ~x ~g.c' Lc~sS e( ~C'`` Contact:
i
Contractor Address: City: rj ) Y,
s533a
ck, S;7
State: Zip: _ Phone:
License 6L (2q L- 07 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:
.m- .e ,w _.e .~~a~m.~ _.W.~ a~ _ .me . moe
NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
I the information may be classified as non-public if you provide specific reasons that would permit the City to i
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 Building Code must be completed within 180
days of permit issuance.. I&-
x d -C, n V l e.1 r- - 'x `
Applicant's Printed Name A ant's S' nature
Page 1 of 3