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4260 Sandstone Drr CityofEaaali Nov 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 2009 Use BLUE or BLACK Ink Permit #: Q:C L77 Permit Fee: t0 ` 0 d Date Received: Staff: 2009 RESIDENTIAL�7BUILDING PERMIT APPLICATION Date: ! //3/09 Site Address: Z4L (-0 (-50)/761,S 0 3 Tenant: Zi ! ( Dct 1/ 1-c ii `e r4? vi J Suite #: RESIDENT / OWNER Name: i f1 "4- 'Dar [exit Alitt % iY) Phone: /16l q - c�7/ (i3 , f 77�� Address / City / Zip: `t O ,_,yt.1"-)cJS-hJr1-t d✓" Applicant is: Owner V Contractor TYPE OF WORK Description of work: abOla ,? ) !O«d Construction Cost:tJt, - Multi -Family Building: (Yes / No ) CONTRACTOR Name:MN WINDOWS.4r SIDING CO. License #: Or 0d /� Address: 8609 LYNDALE AVE. S. City: BLOOMINGTON, MN 55420 State: Zip: Phone: cirR eS 'q (110 q Contact Person: c Jet m es Pop 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: 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.gooherstateonecall.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 �L e Se6. -e t o h Applicant's Printed Name go, x , . d Appl' r s Signatur, Page 1 of 3 ~a.r.~- . . .ne..r-• .+s~iznw,~ , - • For Olfice Uae Only:•••. ~ MECHANICAL PEIiMIT PERMIT # / ~ ` CIT1f OF EA(iAN RECEIPT # 3a30 PILOT KNOB ROAD, EAGAN, MN 55122 CONTRACT PRICE PHONE: 454-8100 DATE: ' 3iteAddreps " i) ? BLDG. TYPE WORK DESCRIP770N Lot ' ' Block i _ ~ ~ub Res. New - % Name Mult Add-on ` -Comm. RepBir Address c City r~~' ' Phone~ - FEES ~ Name RES. HVAC 0-100 M BTU - $24.00 ; Address_`Y - ' ADDITIONAL 50 M BTU - 6.00 ~ Cny ~u. 1 ci e~ Phone '<<' (RES. HVAC INCLUDES A1C ON NEW CONSTRUCTION) TYPE OF WORK GAS OUTLETS (MINIMUM -1 PER PERMIT) - 1.50 EA. COMMlIND FEE -196 OF CONTRACT FEE FarCed Air M BTU APT. BLDGS. - COMM. RATE APPLIES Boiler M BTU TOWNHOUSE 8 CONDOS - RES. RATE APPLIES Unit Heater M,BTU I-t #AINIMUM RESIDENTIAL FEE - ALL ADO-ON & REMODELS - 12.00 Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00 Vent CFM STATE SURCHARGE PER PERMIT - .50 Gas Piping Outlets # (ADD $.50 S/C PER EACH $1000.00 OF PERMfT FEE) Other PERIAR FEE: SlC: ~ ~ TOTAL: FOFi: CITY OF EAG,4N 11VNYLC;`1'lUN KLUUKI) CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: ~ (612) 681-4675 SITE ADDRESS: ~8 l 0( ? ~ APPUCANT: , . > ri , . PERMIT SUBTYPE: TYPE OF WORK: INSPECTION DA • DA }!{il!' . Aki1) ,i~0~AIIr jiII' I II (i! ~ J Permit Holder Date Telephone # PLUMBING HVAC Inspection Oate Insp. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC I TEST - - - - - - - I INSUL I GYPBOARD I FIREPLACE FIREPLAC[ AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL DOMESTIC METER IRRIGATION METER FLUSH MAINS coNOUCTivm TEST HYDROSTATIC TEST BSMT R.I. BSMT FINAL DECK FfG DECK FINAL CITY OF EAGAN Remarks Ced.ar Grove Acquisition Addition Ced.ar Grove #2 Lot 18 eik 1 Parcei 10 16701 180 01 oWner s~reet 4260 Sandstone Dr. State Eagan, MN 55122 ; Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. C 1985 1266.95 84.46 15 STREET RESTOR. GRADING SAN SEW TRUNK * SEWER LATERAL ~ 1972 1304,00 2.1 2 WATERMAIN * WATER LATERAL 972 WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. - SAC PARK cirY oF EAGAN . 3795 PItet Knob Rood Eogon, MN 55122 ~ PHONE: 454-e100 BUILDING PERMIT Rece+pt # To be sud h? Est. Volue Date , 19 Slte Addrcss Erect ? Occuponcy Lot Bixk $ec/$ub, /11ter p Zoninp Porcei # Repoir ? Flre Zone Enlorpe D TYpa of C.onsf. W NO^10 Mo" O # Srories ~ Addross Demolish ~ Length C; pho~ Grade p Depth ~ Sq. Ft. ag Name Appeovals Fees u0 ~ Addrest Asseumenf Permit ~ Cit phorw Woter 8 5ew. Surcfiorpe Police Plon check ~W Nome ~Z Fire SAC 2:3 Addreu Eny. Woter Conn. -W Ci p~ Plonner Water Meter Coundl Rood Unit I hereby acknowledge that I hove read this opplicotion ond stote thot Bldy. 4ff. fhe inlormafion is torrect ond agree to comply with all applito6le ^PC Total ' State of Minnesota Stotutes ond Ciry of Eogon Ordinonces. Sipncfura of Permiftee A Buitding Permif Is issued to: on ths exprcss ca+ditlon thai oll work sholl be done in occordanca wlth all oppllcable 5tate of Minnesota Statutes and Ciry of Eoyon Ordinarxes. Bulldirq Official 'd!O 'ld JMnOS IIoNI :uo! .wool oQlj=oQ IoUlA R15 V /~H IaUlA '041d Isuid oiwlnsul AH 4d^aa ild 46nod -eT ~ ` -9/- • euIwa j uoilopuno~ Sbu!3oo=1 Jeyip •dsu~ eWd uoiiaedwl QO ~ L2 al aUloa13 . '~!Q ~~eM bu!qwnld JePIoH 'oN llwJ6d hsIW AOPIoH 3!tuJed 'oN 3lwAad ~B; ~IAq08200 s Repuesl Date Fire No. Rough-in Inspection g flaquired9 ,~Reatly Now ? Will Notity Inspector c0 O ?Yes ?No WhenReatly? I%licensed contractor ? owner hereby request inspection oF above electrical work at: Job ntltlress (SVeet. Box ar Route No.) Ciry - yz~o an n ~,~~a,.~ $ection No. Township Name or No. Range No. Caunry l.//'+l~~Z"flr OccupantPqINT) Phone No. A P_ L4gl fm ATZ~r ir US~' ~l43 Power Sup lier AddressT- ~L I 1'-A tV1il ElecVica nlranor IGOmOany Ni ConlractorS License No. ~LEGT 1 ~svs Mailing Atldress (COnhacloi or Owner Making Instalialion) 11 C= inc~- o L "1ar\ r ss z Authonze0 ' aNre ICOnlraclouOw Making In9talla[ionl 1 Phona Number lc$ MINNESOTA STATE BOARO OF ELECTRICITY THIS INSPECTION PEDUEST WILL NOT Gtlggs-MlEway BIUg. - Foom S173 BE ACCEPTED BV THE STATE BOARD 1821 UnlversHy Ave.. SL Peul, MN 5510E UNLESS PROPEP INSPECTION FEE IS Plrone (612) 642-0800 ENCLOSED. ~ REQUEST FOR ELECTRICAL INSPECTION ~qJ ~ ? See insWCtions br coryqleling IhisTorm on back oi yellow copy. ~ 08200 X" Below Wark Covered by This Request e Atltl Rep. 7ypeofBUiltling AppliancesWired EquipmentWiretl Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Builtling Dryer Other (Specity) Comm./Industrial Furnace Farm ir Contlitioner Other (specify) ConVacror§ RemaBS: Compute Inspection Fee Below: # Other Fae # ServiceEniranceSize Fee # Circuits/Feeders Fee Swimming Pool O to 200 Amps 0 to 100 Amps Transformers Above 200 _ Amps Above 100 _ Amps Signs Inspectm9 Use Onry: TOTAL Ivigation Booms Special Inspection ~ Alarm/Communicaiion THIS INSTALLATION MAV BE OR ISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, ihe Electrical Inspector, hereby Rough.in oare certify that the above inspection has F;,,ai o_ Q been made. ' OFFICE USE ONLY ~ This request voitl 18 monihs Irom ThisrequestvoidL IUi D`E~lA~ 1pv` S35lz- 1a f116lIth5 ffOT 27600 Renues[Date Fire No, ibugh-in InsVection Pe iretl? ~eady Nuw Q Will NotifY Inspec- a'~ es ?No tor When fleady L]. Licensed Elecvical ConVactor t heraby rapueat inspection ol abova Owner electrical work installeA aC Svee Add/ress, Box or Route No. Ciry~ " ~'IGC~ ecLOn o. Township Name or No. Hange No. Couyly~ (A? 1% OrFupant IPqINT) Phone No. Powergypplier - Address /v a P Elect ical CoMraccmr (COmpany Name) Contractor's License No. O N'lG~ Mailing g AAdres1s ((C1on~(rac^tor or Owner Making Insteilationl ~/tL- \ Auihorized SiBnature ICOntractodOwner Makinglnstallation) Phone Numb r MINNESOTA STATE BOAND OF ELECTNICITY - THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N•191 BE ACCEPTED BV TNE STATE 80AHD - 1821 Univeryity Ave., SL Peul, MN 55700 UNLESS PflOPEX INSPECTION FEE IS 1e,.1 - . ENCLOSEO. ".7. ~ Y,i . . 1 • f 4 L ~ ~ - a . ~ ~ l i. REQUEST FOR ELECTRICAL INSPECTION ee-oaooi.oa Sae in' rur.eions for completine ihis form on back nf yelluw cupy. 276Q0,.t ~ 'R '"X'" Be1ow Work Covered by 7hrs Request 33 SqZ ew P.dd ftep. Type ol BhildinB Appliances Wired Epuipment Wired Home Range Temporary Service Duplex Water Hea[er Lighting Flxtures Apt BuilAing Dryer Electric Heatin Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Far cher vecify Olher tSOecifyl ify O[her Other Compute lnspectian ee Below - !1 ' Fee Service EntranceSize p Fee Feetlers/Subtexdera N Fee Circuits' 0 to 700 qm s 0 to 30 Am s 0 to 30 Am s 101 [0 200 Amps 31 to 700 qmps /4~>a 31 to 100 qin s Above 200 Amps Above 700-Amps Above 100_AmUs TransYormers Remote Control Circ. Partiak%Other Fee Signs Specialinspection $ ~ - P Bomarks TOTA EE .C9 flough-in ' 1 Date ~t al ?~ja-4~ spector, hnreby certify that the above ~a,h~ ~j ' 'k~pectioh hes been nieda. uest voitl eths trom EACAIV TOWNSHIP xo 1083 BIJILDING PERMIT Owaen &..Ar...~...4.~...._/.._~~U--.-rv-:... ~ Eagan Township Address (present) e.......6---------. Town Hall Suildar Daie .1/..~1..~...b.?.~ Address ~ DESCRIPTION Siories To Be Used For Front Depih HeighS Esi. Cost 'Permi! Pee Remarks ~ LOCATION SireeY, Road or oiher Descripfion of Location I Lo} Block AddiYion or Tsac! /9x / 0C - s 4,2;, i q.- ~-e , A5.P 7 C~ 8 m~ This permii does not aulhorise the use of sYreeis, roads, alleys or sidewalks nor does it give the owner or his agen! the righi to cxeafe anq siSuaiion which is a nuisance or which presexils a hazard fo the healSh, safely, convenience and general welfare fo anyone in the community. THIS PERMIT MUST B,EKEPT ON THE PREMIS~E WHILE THE WORK IS IN PAOGAESS. Thie is !o cerfify, -..::.~v,4: ........haspermission fo ereci a....~.g....,.~._._,~.././, upon the above dESCribed premise subjecf io fhe pravisions of the Building Ordinanse fox Eagan Yownship adople April il, 1955. ............_--..KL~:~_-U..T!"'.--'.'~.--------------- Per .....----usac.t-.-e`S'----~i--.~-_........... Chairmen of Tnwn dt Boa~sd / Suilding Inspecior . 13. ~ :~i . S ~ - , FERMIT ° CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: B u z LoIN G Eagan, Minnesota 55122-1897 Permit Number: 032647 (612) 681-4675 Date Issued: Q 7123/9 8 SITE ADDRESS: 4260 SANDS70NE OR LOT: 18 BLOCK: 1 CEDAR GROVE #2 P.I.N.: 10-16701-180-01 DESCRIPTION: ~ REROOF H5E & GAR ~ ~,~,~~YY~~Permit Type STORM DAMAGE ~u,~3'di.ng ~prk Type i2EPATR 44£ensus ~C pd434 ALF. RESIDENTIAL f k ZA = K r x~ 04~ rs n r„. 3 4eE„r>" ea ~ 1eai iAcy upL ~ ep^~ b,x Af j::. .~~..gm -P P REMARKS: REROOF HOUSE AND GARAGE DUE 70 STORM OAMAGE. FEE SUMMARY: CONTRACTOR: OWNER: - Appricant - MARTIN WILLIFlM 4260 SANDSTONE bR EAGAN MN 55122 (651)454-3143 I`hor*by aakrra~~edg,eS have;rea4f this aPp&icdt~,ah a~td eta~e ~hat the ' infarmat ~;Qn is 0°nr.reet and ~gra~ ~a ecrmpJY wittt al„L, applicable SCa ~+f Mn. "Statutes-anti'=Cit+~ af ~as~a~i 9rdiTsi~nces. L r, APPLICANT/PERMITEE SIGNATURE ISSUED BY: SIGNATUFiE ~ 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL) crrsr oF r.aGnx 3830 PII.OT KNOB RD - 55122 ~ j~ 681-4675 ` ~ New Construction Reauirements RemodeUReoair Reauirements ~-~~J qO ? 3 registered site surveys ? 2 copies of plan ? 2 copies of plans (inGude beam & window sizes; poureG fnd. design; etc.) • 2 sde surveys (eMerior additions 8 deGcs) ? 7 energy wlculations ? 1 energy calculetions for heated additions ? 3 eopies of Vea preservation plan N IM platted aRer 7l1193 required: _ Yes _ No DATE: _71ZS~ - w, CONSTRUCTION COST%~~' k~ 0 00" C)C) DESCRIPTION OF WORK: , "0 ~ - '9,-'rm dana4~e, STREET ADDRESS: 6~26O SQiJ o{ S l4z°I ,e- Qr 1576kj~-/%~ LOT: t zS BLOCK: ~ SUBD./P.I.D. Cdj-ek~ G rCfU-2.. ' " f/ U Name: Q~' Ir~'1 i'1'7 Phone ~~/-?j I Y 3 PROPERTY Lacc First OWNER . Street Address: ~ 8 ~ n~J fO .4-)~P City -L?~~ State: I// n Zip: b C'~ l' Comp 6 CONTRACTOR Street Address: License # r City State: Zip: ARCHITECT! ENGINEER Company: Phone Name: Registrazion Street Address: Ciry State: Zip: Sewer & water licensed plumber (new construction only): . Penally applies when address chang and lot change is requested once pertnit is issued. I hereby acknowledge that I have read this application and sfate that the intortnation is corteCt and agree to comply with all applicabl State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY D~~~~ v~ Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received _ Yes _ No _ Not Requi OFFICE USE ONLY BUILDING PERMIT TYPE ? 01 Foundation ? 06 pupiex ? 11 Apt./Lodging ? 16 Basement Finish ? 02 SF Dweiling ? 07 4-plex O 12 Multi Repair/Rem. ? 17 Swim Pool ? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility ? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous ? 05 SF Misc. ? 10 = plex ? 15 Deck WORK TYPE ? 31 New O 33 Afterations ? 36 Move ? 32 Addition 0 34 Repair ? 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. MC/W5 System (Allowable) Main level sq. ft. City Water UBC Occupancy sq. ft. Fire Sprinklered Zoning sq. ft. PRV # of Stories sq. ft. Booster Pump Length sq. ft. Census Code. Depth Footprint sq. ft. 5AC Code Census Bldg Census Unit APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ Surcharge Plan Review License MC/WS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: % SAC SAC Units CITY OF EAGAN 9795 Plls? Knob Rood Fegan, MN 55I22 N~ 7562 • PHON[: 451-8100 - BUILDING PERMIT Receipt Te ba nted fe. GARAGE & ENTRY Est. Value $7.000 Dore October 8 , 19 82 $ite Address 4260 SdndStOAB Drive Erect ~ Occupancy M-1 Lot 18 Block 1 Sec/Sub. 08clar GIOVe 2nd Alter ? Zoning NA Poreel # 10 16701 180 Ol RePOtr ? Fire Zone Enlorge ? Type of Const. Vn W Name william & Darlene Martin MoVe - ~ ? # $tories Address 4260 SdndBtAne Dtive Demolish p Length 24- ci q8n 55122 phom 454-3143 Grode ? Depth 24 Sq. Ft.- ADProra ~ Name W111i8A1 MdLt111 l~ Fees 0 ~t Address ~e SS 3bOVe Assessment Permit 62.50 u~ Cit Phone Wa~er 8 Sew. Surcharge 3.50 Police Ptan check ~w Name Fire SAC Address Erq. Water Conn. . ~W ci p~m pionner WaterMeter . Council Road Unit I hereby acknowledge that I hovo read this appiication ond stata that gldg. Off. the inlormotion is correcf ord ogree to comDlY with all applicoble APC Totol $66.00 State of Minnesota Stotutes Qxy,d'ICit/y~ of -Ec~g-oyn Ordirwnces. Signature of Pertnittee '~A~^~/L3~F/~za!4~ A Bullding Permif fs Issued f~11i8A1 MSTYin on the ezpress corditlon thnt oll work shall be done in occordance wit I applim6le of ot Minnewta Statutes and City of Eagan Ordirwnces. Buflding Official CiTy pF EAGAN Include 2 sets of plans, 1 site plan w/elevations & - ~ BUILDING PERNIIT P.PPLICATION 1 set of enerqy calculations. 4b Be Used Fbr X}~~~w2~~¢ L~v~.: u4 Valuation ~?D oa ~ Date ( u Site Pddress ~4~a . OFE'ICE USE ONLY IDt Z5 B1oCk S2C./Stlb. ~ 4/. EY2Ct Y Occ7P3T1CY44 -7 . Parcel 10 1(o701 Alter Zoni.ng Repair Fire Zone owner: (y EnlarSe _ TYPe of const. Move # Stories Address: Danolish Front 2 ft. Grade Depth 2 ft. City/Zip Code: Ptwne Z/S ~ 3 y ~ APPROVAIS FEES CAntractor: Assessments Permit ~ Pddress: ?4ater/Sewer Surcharge ' ! Police Plan Check City/Zip Code: Fire SAC ~ - g1q, Water Conn. Phone S ~1 •~T 4 ~ Planner Water Meter Council Road Unit Arch•/EnJ• = Bldg. Off. Adclxess: APC City/Zip Code: TUTAL ` C)C) Phone 1 ~ ( ue-zu Z i I~ ~ • i 'I i i . ~ i i i i ~ 'i - ~ ~ . ~ I ~ y ~ 6 iN ~ n im ?rr-- ~ I T ~ (J1 I~ II ~ ~ I~ ~ i I~ ~ 9 ~KA I~ Iw i i City of Eap ~ Parm„t~ ~.~~g 7 ~ I Pertnit Fee: ~0 I 3830 Pilot Knob Road Eagan MN 55122 j Date Recei W7 ~ Phone: (651) 675-5675 ~ ~-~1J Fax: (651) 6755694 I Stafl: 1 ~ J~QG-2 2008 RESIDENTIAL BUILDING PERMIT APPLICATI oaia• ~ site aaaress: renaM: Su 14 RESIDENT / OWNER Name: one: -11-6 Address / City / Zip: Applicant is: _ Owner Contractor _ TYPE OF WORK Description of work: - Construction Cost: Multi-Family Building: (Yes_/ No~ CONTRACTOR Name: License Address: MN wINDOwSB':WING C0. AVE. S ary: s e: r : , . Phone: Cornacl Person: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING _ Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672 EI1Brgy COdO • Residenfial Verrtilation Category 1 Worksheet • New Energy Code Worksheet Cat6gory Submitted Submined (4 submission type) • Energy Envelope Calculations Submined In the last 12 moMhs, has the City of Eagan issued a permk for a similar plan based on a master plan9 _Yes _NO If yes, date and address of masffir plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: ~rtlonsof ; NbTE: P/ens arid suPporling dawrtients that,ypu submit.are cansidered tv be publtc IMarmatFonsPo tfie lnformatton rtiay 6e cYassNled as rron-pub/ic if you provitfe'spftlNc reasons that wwould pBrmft the City ta e5orlctutle th2i t/ie are Ftede seCrets. I hereby acknowledge that this irAormation Is complete and accurate; that the work will be in conformance with the ordinances and codas ot the Ciry oT Eagan; Ihat I understand Mis is not a permi4 but oNy an application for a permit, d vrork is not to start without a permit that the woric will he In accordance wiM ihe approved plan in the case W work which requires a review and al 1 plans. ~ x ,011baM's PriMed~l me Ap caM's Signa A Page 1 of 3 09/13/2019 10:14 6128616267 BEI EXT MAINT EAGAN 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651) 675-5675 TDD: (651) 454.8535 1 FAX (651) 675-5694 gs,i{dln�lnsReg4lons i feagan coo r PAGE 01/02 CfAd For Office Us Permit #: /1 -7 �CT� /moo- a Permit Fee; Date Received: Staff: 2019 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 9l / l'/l y Slte Address; 4'2 (PO 14,1-16.5.7-0/J E b� . geh.A.) 5S/1t Z Unit #: Name: %%r f I. C Phone: Address / City / Zip: 86 °.2 T' U2 S ER" ta A..f SS 1 Z V Applicant is: _ Owner /\.° Contractor Description of work: LAI. OFF o- RE. ' R Construction Cost:'' .Z i Z 0 Multi -Family Building: (Yes _ / No Company: £I Corp-tare/a- m,27.J , . ec P Address: VO 4— LI 100+ti J Contact: btivr4 City: A11,1 -•S State: "3 Zip: SSy/9 Phone: L/;"Zrb' d)K1Email: x.✓P° P i f..Zoc•avt . License #: rd C. A y/,3 / Lead Certificate #: / If theprojectis exempt from lead certification, please explain why: Ria P�.a ; c1j ��2Fkc.1S 4, r--) ry—v Rl3rE.- it 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: Phone: Fire Suppression Contractor. You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's webalte at www.eltvofeaaan.comfsubacribe. 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. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454.0002 for protection against underground utility damage. Cali 48 hours before you Intend to dig to receive locates of underground utilities. w_t_mgapterstateonecall.orq I hereby acknowledge that this information is complete and accurate: that the work will be in conformance_ the ordinances and codes of the City of Eagan; that 1 unticr nd this le not e permit, but only an appllcaton for e permit, and not •may � widwut a permit; that the work will be In accordance with the approved plan in the case of work which requires a review end app x ISA✓. IJ & ✓622VS x 47#16 - Applicant's Printed Name Applicants Signature