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4679 Lista PtCity of Eaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit#: /Z'(�io' Permit Fee: ✓ / /- �J Date Received: : /io/iy Staff: 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: tel° 11 yC/!' !t pt «/6f %((V het .�- Unit#: Site Address: y %� L�3 Resident/ Owner Type of Work Name: AiObeC l 6- /5.1. Phone: ��, � N Address / City / Zip: r' Applicant is: Owner Contractor Description of work: 5/ 0/ '-5 Construction Cost: 51 9- 0 ado • Multi -Family Building: (Yes X / No ) Contractor Company: )V12 .14a.,_ i+ Contact: D'ilElla' ,ero Address: I3?-& 51b2 City: Ovled%SO`le-- State: 1/1111 Zip: SC 3 31 Phone: (01 2- —i-/— lib 5 License #: a- 03f b 7 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 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.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. 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. 6b#1 /1 Cll. e , Applicant's Printed Name x Appli s Signa Page 1 of 3 City of Eagan Eagan, PERMIT City of Eaan Permit Type: Mechanical Permit Number: EA098511 Date Issued: 04/07/2011 Permit Category: ePermit Site Address: 4679 Lista Pt Lot: 2 Block: 02 Addition: Ridgecliffe 3rd PID: 10-63982-020-02 Use: Description: Sub Type: e - Air Conditioner Work Type: New Description: Air Conditioner Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952) 445-2840 Renae Freinwald 2200 Hwy 13 W Fee Summary: ME - Permit Fee (Replacements) $50.00 Surcharge -Fixed $5.00 0801.4088 9001.2195 Total: $55.00 Contractor: Genz Ryan Plumbing & Heating 2200 West Highway 13 Burnsville MN 55337 (952) 767-1000 - Applicant - Owner: Michael B Merryfield 4679 Lista Pt Eagan MN 55122 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 Issued By: Signature Date: City of Eap 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink r For Office Us Permit #: 1 0' i Permit Fee: Date Received: Staff: 2009 RESIDENTIAL BUILDING PERMIT APPLICATION /6 ( Site Address: �6' 7 V 4/'Sv ,Z L Tenant: Suite #: RESIDENT / OWNER Name:/ {��dr /YA 4 Phone: Address / City / Zip: 4' H l /SAt 1 -11 -- Applicant is: Owner ,K Contractor TYPE OF WORK Description of work: (2° 5 i` Construction Cost: 43 Cl. / Multi -Family Building: (Yes >( / No _) CONTRACTOR Name: /‘/(C License #:(-4_` 31e,,..."`' Address: "71-ff ("2,,- jet 't 73 City: a‘hS6ct State: /,,(/(/2 Zip: ,-V-7:).-- '3/ '' Phone: 7!//,27 � l?i/ Contact Person: ,..56C1L /LL'"/�/ 1"t COMPLETE In the last 12 months, has If yes, THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING the City of Eagan issued a permit for a similar plan based on a master plan? date and address of master plan: _Yes _No Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: 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.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,tart 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. fib Applicant's Printed Name 7 Page 1 of 3 City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675-5675 www.ci.eagan.mn.us PERMIT City of En Permit Type: Permit Number: Date Issued: Permit Category: Mechanical EA087876 12/29/2008 ePermit Site Address: 4679 Lista Pt Lot: 2 Block: 02 Addition: Ridgecliffe 3rd PID:10-63982-020-02 Use: Description: Sub Type: e - Furnace Work Type: New Description: Furnace Comments: Quesetions regarding elec 952-445-2840 Stephanie Johnson 2200 W. Hwv 13 cal permit requirements should be directed to Mark Anderson, State Elec cal Inspector, Fee Summary: ME - Permit Fee (Replacements) Surcharge -Fixed $50.00 0801.4088 $0.50 9001.2195 Total: $50.50 Contractor: Genz Ryan Plumbing & Heating 2200 West Highway 13 Burnsville MN 55337 (952) 767-1000 - Applicant - Owner: Michael B Merryfield 4679 Lista Pt Eagan MN 55122 I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State Applicant/Permitee: Signature Issued By: Signature CITY of EAGAN WATER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO • Eajon, 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 City of Eagan Surcharge. Ordinances. J, it By Date of Misc. Charges: Total. Date Paid• Insp • • CITY QF EAGAN SEWER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO • r Eagan, MN 55122 DATE. Zoning: No. of Units: Owner: Address. Site Address: Plumber: agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit. Permit Fee• Surcharge: By Misc. Charges. Dote of Insp.: Total. Insp.: Date Paid: 444') City of Ea�au 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink For Office Usej (C+L Permit#: .I 1 �w Permit Fee: L j —1 �5. 5° Date Received: 1'0 / 013 Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 11)/7/0 Site Address: V`7qj9W3Li5414- I6 8 0.,ituf //Ir4 / ,,J Unit #: Name: Ralie Gl.,, p2 8.14- Phone: Address / City / Zip: Applicant is: Description of work: Construction Cost: Owner )4., Contractor Multi -Family Building: (Yes / No Company: 6/2/24P/ //Z4M P , yhJ' , Contact: f! 45-7,7....h," Address: /2? City: &/".400:04,4 State: 0? Zip: JT3,? 7 Phone: 4/e1- el ‘ — 57:F6' License #: ?- Iti C 6 7 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: Sewer & Water Contractor: NOTE: Plans and supporting documents that you. submit are considered rto bE the information maybe classified as non public rf you provide specific reaso conclude, that they are trade secrets. Phone: Phone: ouolic information s Haat would permit ons, 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 1 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. Applicant's Printed Name x Applicant's Signature Page 1 of 3