4528 Scott Tr _ ~ : CITY OF EAGAN
3795 Pilot Knob Road Eagan, MN 6S1?~2 N~ 6 4 4 9
~ PH~NE: 451-8100
BUILDING PERMIT Receipt # _
Te be ~ped fer Est. Vatue Dcte , 19
Site Address Erect ? Occupanq
Lot Block Sec/Sub. - Alte~ ? Zoning
Pa~~ # Repair p Fire Zone
Enlarga ? Type of Const.
W Ncme ~ Move ? Stories
3 Address - Demofish ? Front ft.
~ Ci Z Phone Grode ? Depth ft.
Ncme AvP~ovab Fee~
o -
u~ ~d~~ . Assessment Permit
f" Ci Phone Water & Sew. Surcharge
Police Plan check
W W Nome Fire SAC
Address Eng. Water Conn.
<W Ci Phone Pianner Woter Meter
Countil Road Unit
1 hereby ocknowledge that I hava reod this applicotion ond state that g~dg. Off.
the information is correct ond agree to comply with oll applicable APC Totol
State of Minnesota Statutes ond City of Eogan Ordinances.
Signature of Permittee
^ Building Permit is issued to: on the express condition that
all work shall be done in ctcordance with oll appllcoble State of Minnesota Stotutes ond City of Eagan Ordinonces.
Building Official
. , ~ I
~
r.n.k # oaf. ~~eo.a P..nIM..
Plumbing 1~~ ~ ~ ~ ~ 1,t~
Mechanical ,.2 ,j -
2~ %
/ ~ J - ~ - ~O ~ c.
INSPECTIONS D TE INSP.
Rough-In Final
Footings Date Insp. Oote Insp.
Foundotion Plumbing ~
Frume/ins. /-/j-~/ Mechonital 3~
Fi~al ~~~~/-SI
Remorks: J~/3 ,G~'C- yi~-o . /l ~
/
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1~'Tr~ . ~ : . . - ~ ' ' ~
- ~ . . ~f (~rru ~nr
~ ~~rftftrtt#p ~ ~J ~
~ ~it of ~agan
~ p
~p~1Al'~YriPITf it~ ~lltl~tri~ .~ttB~iPtfitiri ~
:i ~
Tbis Crrti f iratc iaswed pursiw~ to tbc ~equirnnaat~ of Satiox 3(~6 o
f tfx Uni for+s BNildisg
L p: ~ '
Codc certif
~g that at tix ti~e o f isttratxt tbfs structkrc was in co~n pliana with tlx va~orer ~
, 1';~~
~ ~,i ordi~aanr o
f tix City ngxlati~g bxildirig toiestttittion w xst. For thc f
o!lou7ng:
6449 I
; SF I~ e~a~. r~.~ na. ~ F~
u,e c~.ra~.ea
3
b.l OrwP~Y 7yP~ ~ ~1YP Cos~mctlw V Fir Iant Zatin{ Dutna
o.~ar Zachman Hanes ~aaK. 7760 Mitc~ell Rd.Eden Prai
4528 Soott Tr I.2 B1 Ceclar Cliff 3 ;
~ i s~ ~
9? ~
Buum~Ofec~l ~ D~a: 2-26-81 i~ ~ 'f
g~
'9 lO~T IN 11 COwMICYOV~ RACt
- _ - _ ~.n ~ ? ~i~11~'w~~~~~_~~.'-`Jl.`~'~
`°ir~Y~~C~~a"L1'w>~ i ~'C'~ a
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O.~aa ~N _ _
' ~ CITY OF EAGAN
' , 3795 Pilot Knob Road
Eoyan, Minnerota SSlsz INSPECTOR NOTIFICATION
No. ~ Phewe: 4S4-a100
REQUIRED BY LAW
" ~ '~1: PERMtT FOR ALL INSPECTIONS
- ~ - Receipt No.: ! ~
Singie I
ResidentiGl
Site Addreu: ~ , ^ ' -
Lot Blxk Sub/Sec. -1 ~ r^ Multi Res., Comm./Ind. I
Nome _ _ . , ~ r ; . .
New/Alter,/Repair
. ~ -
; Address ' ~ `
Cost of Instollation
O
City ~7: : Phone: Permit Fee
` Nome rl~g~v;i~,r< Surchorge
~
~ Address _ : ,
City Phone: Totul
This Permit is issued on the express condition that oll work sholl be done in occordonce with all opplioable 5tote of
Minnesota Statutes and City of Eogcn Ordinonces.
Buildiny Official
; ; ctnr oF ~?caN
. 3745 PiloF Knob Roed
Eogon, Minnesala S512Z INSPECTOR NOTIFICATION
No. _ Pti~e: 454-3100
REQUIRED BY LAW
FOR ALL INSPECTIONS
: teat-i_r~< PERMIT
Date: f ~ Receipt No.:
Single I
Sib Address: . Y ~ Residential
Lot Blxk Sub/Sec. Multi Res., Comm./Ind. I
Nome . ~ : ' ` ' New/Alter./Repoir
. . , _ .
; Address ~ Cost of Installotlon
O
City f'~P T~~=`r= ~ Phone: Permif Fee
Nome ~ Surchorge
$ _ _
~ Address
City Phone: Tofal
This Permit is issued on the express condition that oll work sholl be done in accordonce with oll oppliooble Stote of
Minnesota Stotutes ond City of Eagan Ordi~onces.
Buildinp Official
CITY OF EAGAN ~ Remarks
add~t~o~, Cedar C1iff~.Arlditio~ ~ot 2 81k 1 Parcel #in ~~~n~ n~
Owner - Street 4528 Scott Tx'ail State E~an , Mn 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 19$2 1496.30 299.26 5 1496.30 C007335 10-1-81
STREET RESTOR.
GRADING 1982 718.58 143.72 5 718.58 C007335 10- - 1
SAN SEW TFUNK
~t SEWER LATERAL 1,9 82 , 2 ~ ~ 8 ~ 5 `2 ~ . - -
WATERMAIN
~WATER LATERAL L9g2 5
WATER AREA 19']S 94 75 6.3z 15
* Service Stubs 1982 5
STORM SEW TRK ~'~r~ lggl - , 5
~STORM SEW LAT 19 $Z S
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 185.00 22332 12/10/80
1NATERCONN. 3~$.~0 22332 i2~1Q~~~
BUILDING PER.
SAC
PARK
CIY'r ~Jf EAGAN '
3~95 P~~ot Kno6 Roed $~ER SERVICE PE~~T
~9on. MN 55122 PERM17 NO.:
Zonin9= ~ATE:
Owner: No, of Units:
Addresr.
Site Address: '
Plum~r:
°~P~ with tl~e Citr of Eogo~
Ordine~eea. Connection Chorge:
Account Deposit:
Permlt Fee;
BY Surcharge:
Dafe of Insp.: Misc. CFb~ges:
l nsp.: Totcl:
~ote Poid:
C~T' gF EAGAN WATER SERVICE PERMIT
3795 Pilot Keob Road
Eogon, MN 5512Z PERMIT NO.:
Zoning; DATE:
~,~e~. No, of Units:
Address: -
Site Address:
Plumber: '
Meter No.:
Size: Connection ~a~ge:
Reader No.; ~+~ount Deposit:
1 agroe tu eom Permit Fee: '
P~!' w'1N+ tf~e City oi Eago~ Surchorge:
Ordinonees,
AAlsc. Chorges:
B Totol:
Y
Dote of Ins ~ate Poid;
P ~ Insp.:
~ bd
This request void ~ x~ ~ ~ '3 ~ ~ ~ -
18 ~on.ths"~rom
Date of this Request 12-18-80 Fire No. T~ J~~~
I, as ? Licensed Electrical Contractor OOv?mer, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. ~+5z8 ~cott Trail City Ea~an
Section Township Range County Dakota
Which is occupied by Zachman Homes
(Name of Occupant)
Is a roughin inspection required on this job? No ? Yes ~ Ready Now ? Will Call ?
Power Supplier Dakota Electric Address
Electrical Contractor S~rise ELe c tric , Inc . Contractor's License No. 39778
(COmpa~y Name)
Mailing Address 4~ ~g $~r~..~Y~~~..~p 55443
j~lectr cal on r~[oY` Asr This Installatlon)
Authorized Signature Keith R. Hesli Phone No. 566-8600
(Electrlcal Contractor or Owner Makfng 7his Installation)
~ ST~~'E B0~1RD COPY This inspection request will not be accepted by the
State Boerd unless proper inspection fee is encfosed.
m~n~naem awin waru m nacinuny
Griggs Midway Bldg. - Room N791 EB-00001-02
1821 U iversity Ave., S[. Paul. Minn. 55104 - Phone 297-2171 ~ /~'9
CHECK ~OW WORK CO EREDTBY' TH S EQ EST ~ON ~ a} T 19 7 8 3~
7ype of Building New Add. Rep, Check Appliances W'ved For Check Equipment Wired Fm ~
Home ~ ? Range ~ ? Tempoxary W'uing ?
Duplex ? ? ? WalerHeater ? LightingFix[ures ?
Apt. Bldg. ? ? ? Dryer ? Electric Heating ?
Commeicial Bldg. Fumace ~ ? Silo UNoader ?
]ndusirial Bidg. ~ A'v Conditioner ? Hulk M0k Tank ?
Farm ? ? ? List List
Other ? ? ? HereIS~ Herets~
7
COMPUTE INSPECTION FEE BELOW
SecviceEntranceSize: # Fee Feeders~Subfeede~s: a Fee Cixcuits: # Fce
0 m 100 Am s. 0 to 30 Am eres 0 to 30 Am eces
101 to 200 Amps. 31 to.100 Am 7es 31 l0 100 Am eres
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Transfocme[s Remote Conlrol Circ. Pattial or o[her fee
Signs Special Ins ec[ion Minimum fee $5.00
Remarks TOTAL F
~ ~'0 2 00
(Rough,in)n~s: ~~tifythatth~a'lS~ev in atee ma~~ ~
/ 30~
~
(Final) ate,,. (p- /~~S'
This request void ~
18 months from
CITY OF EAGAN
3795 Pilot Kno6 Rood Eagan, MN 551?3 N~ 6 4 4 9
. ` PHONE: 454-8700
BUILDING PERMIT APPLICATION Receipt #
To be uwd h. SF DWG est Volue 33~000 pore 12-10 1gg0
$ite Address ~+`J2$ SCOtt TY'. Ere<t ~ Occupancy R3
Lot ~ z Block 1 Sec/Sub. Ced3T Cliff 3 . Alter ? Zoning R~-
Porcel # ~ Repoir ? Fire Zone 3
Enlarge ? Type of Const. V
z Name 2ac'11man NOR1PC Iric' _ Move ? # Sfories
; Address 7760 Mitchell Rd. Demolish {7 Front 22 fr.
° Eden Prairie,N1~~„e 937-9520 Grode ? Depth 3g rr.
~ Neme ApPrmals Fees
0
o'~ Address Assessment~ - Permit 98.00
V~ Ci Phone Water & Sew. Surcharge 16. 50
Police Plan check 49•0~
ww Name Fire SAC 525.00
rZ
Address Eng. Wnter Conn. 0. ~0
aw Ci Phone Planr~er Water Meter 0 0
Council Road Unit 185.00
I hereby ockrrowledge that I have read this applicotion end smre that g~~j, Off.
the information is corred and agree to comply with all applicable APC Tofal 1~3$.50
SMfe of Minrtesota StatuYes and City of Eogan Ordinances.
Signature of Permittee
A Building Permit is issued ro: ZBCklman Homes Ine. a„ ~ e~ress condition ihat
oll work shvll~ be done in occordance
'tc
yp h oll_,npplica Sta,t,Ce
~of Min~esW4 Statutes and City of Eogan Ordirwnces.
Building Offictol ~''r~~"~ ~
1,, ~ CTTY OF EAGAN _ Include 2 sets of plans,
~ 1 site plan w/elevations &
BUII~ING PERNIIT APPLICATION . 1 set of energy calculations.
valuation 33 o Q D Date
Zb Be Used For
s~r.~ Aaaress: ' 1 _ or~zcE vsE orux -
. ~~,y - .P 3 -
Iot ~L.- ;Block Sec./S1~b Qv Altps Zoning ? 1
Parcel - ge~ i r Fire Zone °S
~larqe 'I~pe of Const. V
Qaner: ~aC~Y`f~AY1 ~ 1~J! Nbve # Stories ft.
Pddress: p- • Derolish _ FYOnt ft.
L ' Grade ~P~
City/Zip Oode: C~ttr°n
Phone 93~-s~ ~ APPF~IPSS
Assess[~nts PeL~nit 9~ o~
(bntractor: Waber~Sewer Surcharge / G~ s G
Pddress: Police Plan Check y~ .oa
Fi~ ~ S2~ a d
Ci~y/Zip Code: Water Conn• 3 aS• ~o
Phor~ Planner Water Meter G D.6 0
Council R1k~d Uliit /
R<'•
a
a
A~h,/ESig. - Bldg. Off.
Address: ~
Cit}'~Zip Code` / ~ 3~. S`(~
7VrAi. ~
Phone
Cd1LVI~V H. HEDLUN • 9609 Girard Av~nus SouM
, Bloominqton,Minn~sofa 55431
Land Survayor Civil En9ineer - pAon~:888-2080
surve~or~s G'ert~,
f
"~cate
JOB N0. 143
(
SURVEY FOR~Zachman Homea ~
DESCRIBED AS~ ~t 2~ Hlock 1, CEDAR CLIFF 3RD ADDITION, City of Eagan,
: Dakota County, Minnesota, and reservinq easements of record,
i
qo4.8 qo4.5
~ _ 75.00
, r_
i ~
~ V ~ 0! M
o
1 I ~ Z
I ~
~ i r33 easc~ o~K Top of Founda~ron =904•5
1 N
( ~I io $asemenf Floor~ 9~1•3
N~ r_ 03.8 22_: Gerd9e Floor = 904.1
-I /r - - ~i \ ~ Droposed Eleva+ions O
Fu~ ~ o^Kwao° ~ , Exis~rn E~evat~ons _
IomS+~k~s i~ ~ iop 9
;N GAR sp~~+~ SPdkes ~^ofes Dr.ifnaye
~ ~Jo b{~ye~ ~'1 12~ Denofes Lot Corner O
I ~ I
~ ~ ~
~ ~ ~r9o3.a o3.
/ ~ ~ ~ w I ; r- :
L_~'! - ~ ~ p'~ j
I i ° ~
`Y~a _ nl
901.4 ~ ,pp 901.0
O ` p
~ M
901.1 SC07T TRAIL 400•'1
9oi.o
CERTIFICATE OF SURVEY
I here4y ce~tify fhat on ~ I- Zb - 80 I surveyad the properiy deicribaG obova and fhaf
the above plat is a correct representatioo of said aurvey.
~ v~.:,.- ~ ~-~d~^~
~ Calvin H. Hedlund, Minn. Rey. No. 8942
l~
~ For Office Use I
City of Ea~a~ i Permit u: O 3~~. ~ i
~ Pertnit Fee: ~ 7 U ~
I
3830 Pilot Knob Road i ~_l~ i
Eagan MN 55122 I oate Received:
Phone:(651}675-5675 ~ G~~ i
~ Staff: ~
Fax: (651) 675-5694
2008 MECHANICAL PERMIT APPLICATION
Date: ~G ` ~ a-~~ Site Address: 7~ a~ ~~D'~'"~ l i~GC_,l ~
Tenant: J1 cit(~ Suite#:
RESIDENTIOWNER Name: c Phone: ~D~r7-- ~~'~~ag
Address ! City / Zip: c3 '~~--~-1
CONTRACTOR Name:~1~~~45 C~M~GY~ i,l~. License
~130 ~ ~D`'~~ '
AddresS ~ ~ r
City: State: Zip: ~~7.`Y-Y~
Phone:~~~' O 3~~ Contact Person: ~ S
TYPE OF WORK - New ~ Replacement _ Additional _ Alteration _ Demolition
Descrlpilon of work: ~
NOTE: Both roo/ mounted and ground moun~ed echa ca! equlpment rs requlred ~o
be screened by Clty Code. Please contact the Mechanical Inspector or one of the
Planners for informatlon on ermitted screenin me~hods.
PERMIT TYPE RESIDENTfAL COMMERCIAL
~ Fumace - New Construction _ Irrterior Improvement
Air Conditioner _ Install Piping _ Processed
Air Exchanger _ Gas _ Exterior HVAC Unit
- ' HVAC units must be screened ~
_ Heat Pump Under / Above ground Tank Install! _ Remove)
Othei " When installinqhemoving tank(s), call for inspection by Fire
- Marshal and Plumbin Ins ctor
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.5o State Surcharge)
$90.50 Fife rep8lr (replace burned out appliances, duchvork, etc.) (includes $.50 StaTe SurCharge)
$ ~~SV TOTALFEE ~
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x 1%
$50.50 Minimum (includes State Surcharge)
- $ Permit Fee
- If Permit Fee is 1e55 then $1,0~, surcharge is $.50.
- If Permit Fee is >$1,000, surcharge increases by $.50 for each State Surcharge
$1,000 Permit Fee (i.e. a$1,001-$2,D00 Permd Fee requires a$1.00 surcharge).
$ TOTALFEE
I hereby acknovAedge that [his information is complete antl accurate; [ha[ lhe work will be in conformance with lhe ordinances and codes of the City of Eagan; lhat
I understand this is not a pertnit, 6ut only an application for a pertnit, and work is not ro start without a pertnit; that the work will 6e in accordance with the approved
plan in the case of work which requires a review and approval of plans.
_,~..5`~`L c~ ~~.C~ C,l l S X
Applicant's Printed Name Ap i anYs Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough In Air Test Gas Service Test In-tloor Heat Final
41/1'
City of bpi
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
RECEIVED
MAY 112012
2012 RESIDENTIAL BUILDING PERMIT
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee: / 7 •
Date Received:64f
J( Dif
/ 7-
/o 6/ 3
Staff:
APPLICATION ttr:-(/ � �6 .
51111 0'fl-- Site Address: iii5P16 SC0 — I
Unit #:
Name: MO(242A4 L , litk V S
Address / City / Zip: t,1 $vit— 4Gt. Pr
Applicant is: IX Owner Contractor
Description of work:
g4.`cr 12kk
Phone:? —105-746424
Construction Cost: OC).
6641
Company:
Address: City:
State: Zip: Phone:
License #: Lead Certificate #:
SeAF
Multi -Family Building: (Yes / No , )
Contact:
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:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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.qopherstateonecall.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 authorizeby a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issu
App ant's Print Vl Name
Applicant's Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation Fireplace
Single Family Garage
Multi J Deck
01 of _ Plex Lower Level
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25%_ 100%
Census Code
# of Units
# of Buildings
Type of Construction
Interior Improvement
Move Building
Fire Repair
Repair
gaga
11341
/13
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
REQUIRED INSPECTIONS
Footings (New Building)
yie Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
Fireplace: Rough In Air Test Final
Insulation
Sheathing
Sheetrock
Reviewed By:
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
Siding
Reroof
Windows
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
Demolish Interior
Demolish Foundation
Egress Window Water Damage
*Demolition of entire building — give PCA handout to applicant
-X-116
'."7
PFJ
zcy
/,2
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Other:
Pool: _Footings Air/Gas Tests Final
Siding: Stucco Lath Stone Lath Brick
Windows
Retaining Wall: _ Footings _ Backfill Final
Radon Control
Erosion Control �
, Building Inspector fAippfro*. .- Q. /7 T f2aa 2 -
/0 3 9'
Ci 7
S&W Permit & Surcharge
Treatment Plant
Copies /,Z
TOTAL
�G'irc? //M
3 96o
Page 2 of 3
CALVIN H. HEDLUN
Land Surveyor
Civil Engineer
•
Siarafors Certificate
9609 Girard Avenue South
Bloomington,Minntsota 55431
Phone :88 a-zo 80
JOB No,
SURVEY FOR: Zachrnan Homes
DESCRIBED AS1 Lot 2, Block 1, CEDAR CLIFF 3RD ADDITIOy, City of Eagan,
Dakota County, Minnesota, and reserving easements of record.
*MEM ••1••••••...sile•
0
904.B
/04.S
r-
75-.00
0I
01
tfij
0 KWOO
io1(9
S takes
0
0
To p of Foundation :c104.5
i3ement Floor s 40f. 3
Gar.s5e Floor s 904.1
Proposed Elevation*.
axis fins Elevations —
C)enotes brafriaoe
noteS Lot Cor rte r 0
;
901.4
0
901.1
1-19-03.8
1 75.00
0
ra
cLOTT 900,1
EAGAN
REVIEWED
BY:
fivRyfy " -7Y)NS DIVISION
i.!,“:,ret-,)y certify tic i c - 2,6 -BO Fwvoyed the proporly doteribed obovt ond that
the -ot)ev plot is a corn representation of sold survey.
Calvin H.Hediono, mn.ReNo.
Use BLUE or BLACK Ink
s i i
For Office
i _
City of E Q Permit*
I I
~ Permit Fee: {
3830 Pilot Knob Road q
Eagan MN 55122 1 Date Received: I C
Phone: (651) 675-5675 I {
Fax: (651) 675-5694 1 Staff: 1
.
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Address; L { _~,_2`' ----------------knit
Name: Phone: 2- q 4 2 (--)7 2.
Resident!
Owner Address City Zip: 2 S G c`" 3 LPL
Applicant is: Owner r Contractor
Type of Work ; description of work: _ ~y~~ 1 n t ,
Construction Cost `u i Multi-Family Building: (Yes /No
7
Company k Contact: t-VIe.-t
Contractor address 3_ t jr two t City:
State:
Zip: (1 i ! Phone:
License ~ L LJ -7 ~ _4 2-- Lead Certificate
77
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:
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 Cali at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. 21T;<,N ~r
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 bya building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit Issuance.
Applicant's Printed Name Applicant's Signature
Page 1 of 3