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2135 Silver Bell RdCity of Eagan Eagan, PERMIT City of Eaan Permit Type: Mechanical Permit Number: EA096728 Date Issued: 10/29/2010 Permit Category: ePermit Site Address: 2135 Silver Bell Rd Lot: 000 Block: 079 Addition: Section 18 PID: 10-01800-021-79 Use: Description: Sub Type: e - Furnace Work Type: New Description: Furnace Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, 952-445-2840 Renae Freinwald 2200 Hwv 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: Judy L Herrick 2135 Silver Bell Rd 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 CASH RECEIPT CITY OF EAGAN 3795 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE 19 RECEIVED FROM AMOUNT $ 4 DOLLARS goo ? CASH ? CHECK /i l ? 1 'e d '..g ` _" i - FUND CODE AMOUNT ` fr. Thank You BY r'J White-Payers Copy Yellow-Posting Copy Pink-File Copy CITY OF EAGAN Remarks I 1 _ ??».(1ts Addition Section 18 Lot Blk Parcel 10 01800 021 79 O, e? , ti?? ` '- d- '?/ Street 2135 Silver Bell Road State Eagan, MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 1821.38 364.28 5 .1821 . 3 0010471 53-1812t STREET RESTOR. 1-98-2- 18=T6- -36-.&& -& GRADING SAN SEW TRUNK 1968 $100-00 $3.33 * SEWER LATERAL (4 3 1982 3571-70 2 38.3.1 15 ie;R7 C007736 1989 ' !)33 08 19887 1 r, 1-Q3-A 0Q C008743 -14-83 WATERMAIN - - • WATER LATERAL 1982 15 WATER AREA,;' 00 F. rr c< ._ • r f - * Services 1982 15 STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 185.00 24404 4-28-81 BUILDING PER. SAC 525.00 PARK a A-f.??ud'? ? /.J?¢s-sc.ti?'.? r? Gi?i^a?:-,.?/A?/NI??C'^u7??? t? G?c?f'??G G ./7?'Y?J4?t/? 4f 6 9 S. ?° ?'' ?u,?,?aa/a?S.????• 4a-r1 c?.z o? « ,r.? ' yam- ?' ??? --? ? . / 9?/ • ? G ?. ? 98? [ITY OF EAGAN 795 r Knob Road San, MN 55112 ing: ner: dress: ite Address: lumber: 1 agree to comply with the City of Eagan Ordinances. Rv Date of Insp.: SEWER SERVICE PERMIT PERMIT NO.: DATE: No. of Units: Connection Charge: Account Deposit: Permit Fee: Surcharge: Misc. Charges: Total: Dote Paid: CITY OF EAGAN WATER SERVICE PERMIT 3795 011- Knob Road PERMIT NO.: Eag--n, MN 55122 DATE: Zoning: No. of Units: Owner: Address: Site Address: Meter No.: Connection Charge: Size: Account Deposit: _ Reader No.: Permit Fee: 1 agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: By Date of Insp.: Total: Dote Paid: ?°s ? 56 ' 3 p 5 1g do° Request Dale S s/ Z Fire No. Rough in Inspection Required? ?ieady Now ? Will Notify Inspector When R d ? 7 _ Yes No y ea licensed contractor ? owner hereby request inspection of above electrical work at: Job Address (Street. Box or Route No.) -Z) 3 S S, /vc r ??Jr Kck City G. avN $S/i Section No. Township Name or No. Range No. County Oecupaot(PRINT) 6ro -e Z Phone No. L{Sy-114 v - vl a- rncc. Power Supplier Address Electrical Contractor (Company Name) ConiraMOrS License No. Mailing Address Contractor or Owner Making Installation) Spa; Z 7'".?-t. se n7 /S .v SS Authorized Signature ContractooOwner Making Installation) Phone Number ,n i --/ /Yi P..t?o 7l -6466 MINNESOTA STATE BOARD OF ELEAICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 662-0800 ENCLOSED. a f/?? jp? REQUEST FOR ELECTRICAL INSPECTION r'' 22 Ee-00001-0 ? See instructions for completing this form on back of yellow copy, , T:H:°?.? LL?P -? "X" Below Work Covered by This Request evJ (Add Rep! Typeot Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Healing Apt. Building Dryer Other (Specify) Comm./Industrial Furnace Farm Air Conditioner Other (specify) contractor's Remarks: Compute Inspection Fee Below.: GO1??''tt "o # Other Fee # Service Entrance Size Fee # CircuitsrFeeders Fee Swimming Pool 0 to 200 Amps 0 1'OQ Amps Transformers Above200_Amps Aboi -Amps Signs Inspectri Use Only TOTAL Irrigation Booms ? V d , S d Special Inspection Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 MONTHS. I, the Electrical Inspector, hereby Rcugmin Date certify that the above inspection has been made. Final Date f J OFFICE USE ONLY This request wttl 1B months from Liz ? 77 21-z g- P °' ®s??ea (?p?r - EAGAN TOWNSHIP BUILDING PERMIT Owner \e.r --?-u//y/ -+- -- ,( .....--'---/-1.?.-?-- --'------ Address (present Builder .............. k CYti!^.c:`U ------ _...------ ----- '----- ---------- --------'--.. Address ................. DESCRIPTION /O I Srdo C946;>Y N° 177 Eagan Township Town Hall Dale .:.......py!...---0'../.-....'---.... Stories To Be Used For Front Depth Heigh! Est. Cos! Permit Fee Remarks _ LOCATION t or This permit d not authorise the use of streets, roag, alleys or sidewalks nor does! give the owner or his agent the right to cr to any situation which is a nuisance or which presents a hazard to the he4lth....9a_fety, convenience and general welfare to anyone in the community. THIS PERMIT MUST B5_ T R MISE WHILE THE WORK IS IN PROG SS. f This is to certify, that..- .....°.. .. .--`----........has permission to erect a ------------------------ ...................................upon the above described premise sub" ! pr visions of the Building Ordinance for Eagan Tow ip adopted April 11, 1955. ..._....._._.-- Per ....... ............ _...----.......-`.----.....-- --...`..._ ............................... Chairman of Town oa Buildingg Inspector l RUG-13-2008(WED) 16:01 Dakota County PDD (FRX)9528917000 P.002/002 G7 UU N WATER RESOURCES OFFICE GROUNDWATER PROTECTION SECTION 14955 Galaxie Avenue - Apple Valley, MN 55124 9s2.891.7557 - Fax 952.891.7588 - www.co.dakota.mn.us MUNICIPAL NOTICE OF WELL SEALING PERMIT APPLICATION DATE: August 13, 2008 TO: Tom Colbert/Wayne Schwan (EM) RE: Well Permit 4. 08-H257827 Municipality: Eagan Fax #: (651) 675-5694 Well Type: Domestic Water Resources Specialist: Luehrs The Dakota County Water Resources Office has received the following permit application for the well described. If you require further review of the application or if you have any questions or concerns about it, contact the Water Resource Specialist listed above or our office at (952) 891-7557. If there is no response from your office within 24 HOURS (excluding weekends and holidays), we will assume that you have no objections to the issuance of the permit. Please note that permit issuance is always conditioned on the permit applicant's observance of and compliance with all applicable state, county, and municipal laws and codes. Well Contractor: Date Application Received: Anticipated Drilling Date: Anticipated Grouting Date:. Property Owner: Well Owner: WELL LOCATION: Bohn Well Drilling 8/6/2008 Eunice Groven Eunice Grovcn Time: Time: PLS Coordinates: 1/4, SW 1/4, SW 1/4, SE 1/4, Sec 18 Town 027 Range 23 Street Address: 2135 Silver Bell RD PTN Number: 100180002179 WELL TNFORMATION: Diameter.. Casing Depth: Total Depth: Static Water Level: Aquifer: COMMENTS: PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. NEW CONSTRUCTION X ADD-ON A/C _* ADD-ON FURNACE--XPE, -e?-6r.r( FIREPLACE INSERT DATE FEES HVAC: 0-100 M BTU $ 24.00 ADDITIONAL 50 M BTU 6.00 GAS OUTLETS (MINIMUM 1 @ $3.00 EACH) ADD-ON/REMODEL (EXISTING CONSTRUCTION) $ 20.00 STATE SURCHARGE .50 TOTAL SITE ADDRESS: OWNER NAME/. TELEPHONE #: INSTALLER: ADDRESS//:__ CITY: C ?j_Vozoq? STATE: ZIP CODE: S?/v TELEPHONE SIGNATURE -OF PERMITTEE 1994 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 6814675 1994 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN SS122 (612) 6814675 PLEASE COMPLETE FOR ALL COMMERCIALANDUSTRIAL BUILDINGS. ALSO COMPLETE FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. DATE: NEW BUILDING INTERIOR IMPROVEMENT WORK DESCRIPTION: CONfRAUF PRICE: FEES 1% OF RMIM FEE $ PROCESSED PIPING: $25.00 MINIMUM FEE: $25.00 STATE SURCHARGE $.50 FOR EACH $1,000 OF FEE. TOTAL $ SITE ADDRESS: OWNER NAME: TELEPHONE #: TENANT NAME: (IMPROVEMENTS ONLY) INSTALLER: ADDRESS: CITY: TELEPHONE STATE: ZIP CODE: SIGNATURE OF PERMITTEE CITY INSPECTOR C !d't rIUi TFO:i AM AU*rKJH 'X.'1O:T FOR DCZ;%YEP 1'i.'l.-L= iii 74:: 7.4 cPV.-L1L AS3EL;SAMrr3 =OR SENIOR CITIZENS' 1.10MESTEAD r.1US 1.374, CFLIPT= 206 STATE OF HIMMZOrA ) COUNTY OF DMOTA ) DATE AT) l 20, 1982 '.b: Co;rnty Audi:cor, Dakota County, 14innesota I, the undersigned, declaru ;order penalties of perjury: Thai: I rezida at 2135 Silver Bell Road, Eagan, MN SS122 That I as !tut Isez; -*,Ian 65 years of age and that the date of my birth is Oct. 122 1916 `That i att the owner of the property legally described as: see attached sheet Property Identification No. 10 01800 021 79 That my interest in the ownership of the above property was aquired on April 19 63 and is as follows: 1. Solo ownership (Enter yes, if applicable) 2. Joint tenancy- held with 3. Other undivided interest (Specify) That on January 2, 19 or June 1, 19_6a.__ I owned and occupied the Sbove property as my homestead and such occupancy began en k L 19yz TUat the installments for improvements on the special assessments duly adopted in ordinance by the r; rv r? . r; t o£ F,_ as of cec which h;:ve been allocated against the subject property would create undue personal hardship or my behalf and I respectfully request that payment be delayed and that n ch ins; ailme-nh. x so deferred for the y ears 19 1?9 ;,,,;;,??;.,,ite?p Signed Owner I, ?,S• Vo ..?v t-Ab± e- , Clerk of the of? n a in a county, State of 14inneso , do hereby certiiy at the agplica"On of Ln%-2 ,,even above named, has been duly reviewed and that it accordance with the minates of official record in said chambers was duly APPROVED or %QqMP As of That in accordance with approval granted, the special assessments listed below e: tb: affiants subject property levied for annual collection in the amounts and for the years shown be so deferred with interest at the annual rate shown until such tirna it is deemed the applicant no longer qualifies or,the property loses its eligibiiit;• Years of Nave of Auditors D/P 'IotaR CollleatIon Tntb rust - Assess nt Ntanl?er No. Amount (Inclusive) Rr to n ?? ?trret Seeger F. Wgr-nr Tntc F;? 99 /G38 e a S 4 TS 8° Dated April 20 19 82 ld QAMA,}Lk Yz (; k or authorized Deputy) y " (t r'4 . CITY OF EAGAN Addition Secti Ov%rher Remarks Lot Blk Paroel 10 01800 021 79 Street 2135 Silver Bell Road State Eagan MN 551 U.r. tr IL.1L K /.1i -Sri a?.Ll4_ 1Z1L u- -... Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. Grr,l 1821.38 364.28 5 _ _ J??l 4 9 /fl y7 ? : .B 3i' BcS? STREET RESTOR. 1982 182.76 36 55 $ 1 - . GRADING - SAN SEW TRUNK 1,968 Sion-no $3-33 30 *SEWER LATERAL 4 hI -- 1982 3571.70 238.11 1 I As C, 2 _ igg? 1933 08 /S o L,ta u 3 WATERMAIN * WATER LATERAL 1982 15 WATER AREA * Services 1982 15 STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK /.N. STREET LIGHT WATER CONN.. 18$.00 24404 4-28-81 BUILDING PER. 'r SAC 525.00 n u PARK f tw Ku? c? a / ? _ D f. - _r . ?,?[ ,.QS-,a.?.? C?...? ?,?! ? c/M¢,G?.-tc. •L±-:L ?"iec?.x-.u-2'?G G ?...C' _ /?' //i -EYa-- l?"-?ir?+fiv C?sr?.ir?i L/ nG??-C a.-• ??/?/ . ? CJaevL4I ?//?a 44 46a.Ln u-.?52 f / D - 67,/- 7, of pagan 3830 PILOT KNOB ROAD THOMAS EGAN EAGAN, MINNESOTA 55122-1897 Mayor PHONE: (612) 454-8100 DAVID K. GUSTAFSON FAX: (612) 454-8363 PAMELA M4CREA TIM PAWIENTY April 17, 1990 THEODORE WACHTER Couxil Members THOMAS HEDGES City Administrator MR LAWRENCE GROVN EUGENE VAN OVERSEKE Cay Clerk 2135 SILVER BELL RD EAGAN MN 55122 Dear Mr. Grovn: I appreciate your stopping by the Municipal Center to see me. As my secretary told you, I don't keep regular office hours at the Municipal Center but she has passed along your inquiry to me. Our records show that you hooked up to City sewer and water in April of 1981. Residents in the Wuthering Heights neighborhood who were recently hooked up to City water received that service because of concerns regarding contamination and because some of these wells were beginning to dry up. The Metropolitan Waste Control Commission paid for the hook ups. The City is not in a position to offer to rebate any of the costs to those who hooked up to City water in the past. If you wish to appeal to the Metropolitan Waste Control Commission for a refund, I would suggest you write to: Gordon Voss, Chief Administrator Metropolitan Waste Control Commission 230 East 5th Street St. Paul Minnesota 55101 I'm sorry I can't help you with your request but I hope you will feel free to contact me at any time you feel I can be of service. Mayor TAE/kf A. THE LONE OAK TREE ...THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY Equal Opportunity/Affirmative Action Employer J ? 3 Z -16 rt f? . i - -- ----- -- -- -------- - - -- - - BEA BLOMOUIST , MAYOR •. _• _ 'h y„ ' PA ..Sdr1 CITY OR EAGAN MAR RRANTO ; - JAMES A. SMITH THEODORE WACHTER - ' ••?j.y,y ?9TD6 PILOT ;KNOB ROAD' :• COUNCIL MEMBERS EAGAN." MINNESOTA •° 55122 ?. PHONE ./840100 _, ?• v Y2 aY? April 20, 1982 THOMAS HEDGES CITY ADMINISTRATOR EUGENE VAN OVERSEKE CITY CLERK Dakota County Government Center % Auditors Office Hastings, MN 55033 Attention: Peg Dear Peg: RE:' Parcel 10 01800 021 79 i Lawrence E. 8 Eunice Groven 2135 Silver Bell Road, Eagan, 55122 This letter is to notify you that the special assessments that were levied for 1982 for the above mentioned legal have been deferred. The deferrment is on data processing numbers 681 and 637. Please issue a new tax statement showing the correction for payable 1982. If you need additional information please call me at City Hall. Thanks for your assistance. Sincerely, Ann Goers Assessment Clerk THE LONE OAK TREE ... THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY. x NOTICE OF SFE"It F.SSESS''E^;T The Eagan city council meeting on June 16 1981 approved and adopted special assessments against the follaaing described property : SEWER AND WATER LATERALS AND SERVICES X"Parcel # 10 01800 020 79 for the following irprovemnts in the designated amounts: K%TER Area El I Laterals ?X Service El Lat. Benefit/ from Trunk STOP-M 0 Area M Laterals SA.=APY F-1 Area ® Laterals Service Let.Benefit/Tnuk STREE.': S PtKXP`1'I' (YPS) 45g 79 c, -15 ? ? 1158.46 15 Grading/Gravel Base 0 Surfacing Q Res. Equiv. AHCUMf (YRS) TOTAL $ zLZ 30 Any portion of the total amount of these special assessments may be paid within thirty (30) days of adoption of the assessment roll without interest at the Eagan_ City Hall after which any remaining amrnmt will be certified to the Dakota County Auditor at Hastings for annual installment payments (principal and interest) w`zich will appear on your future property tax statements. If the special assessment balance is not paid within this 30 day period but paid prior to Octot r 15th in the year of adoption, interest will be charred fror the date of adoption to December 31st of that year at the rate of 5.9 If the assessiment is not paid by October 15th in the year of adoption, it will be certified to be paid in annual installments at the rate of 11 % per year interest. The first year's installment to show on a tax statanent will then include interest from the date of adcpticn to December 31st of the following year. The law provides that unpaid assessments will became a lien against the property. State law, :Minnesota Statutes Section 429.081, provides that you may appeal your assess.,ent within 30 davs after the adoption of the assessment by serving a notice of appeal upon the mayor or City Clerk of Eagan providing that a written objection sinned by the affected property gamer was filed with the City Clerk prior to the assess,ent hearing or presented to the presiding officer at the hearing. You must file the notice of appeal with the Clerk of District Court, Dakota County, within 10 days after serving it on the Mayor or Clerk. SPECT-AL ASSESSME24T DEPAP!L04T City of Eagan 3795 Pilot Knob Road Eagan, Minnesota 55122, . Social Security r Award Certificate { From: Department of Health, Education, and Welfare Social Security Administration 1 r.I-, ,- Date MAR. 14. 1980 Claim Number: 472-28-Ob14 HA LAWRENCL E GRCVEN Type of Date of Monthly F IV RANCH RD gc^.afit Entitlement Benefit BX 14 ESTERO FL 335261 DISABILITY 10/79 f 492.50 THE AMOUNT OF YOUk FIRST PAYMENT IS $2462.50. INCLUDE ALTLERBE3N/L07FI/609 AFPAYMENTYFORT$492C50 WILL SHORTLY WILL Bc SENT CV ut. AdOJT 4/03/80. AFTER THAT, A PAYMENT FCR $492.50 WILL BE SENT LASH ML,NTli. YCJ TTHISARLEERTNIOTFIECLAIIGEIOL6EFNTOIRTLANY ANC•THERFIENCFITRONHTHISTOREANYN CTHLR RECORD IN THE FUTURE- REQUIRES A SLPARATt APPLICATION. IF YCU BELIEVE THIS CETERMINATICN IS NuT CORRECT. YOU MAY REQUEST THAT YOUR CASE at REEXAMINED. IF YOU WANT THIS RECONSIDERATION, YOU DATE RECEI MUST KE?.UEST IT -1 NOIIC'L. YCU MAYyHAKEAYCUR THAN DAYS M ANY THE SDLIALYSECURITYVE THIS OFFICE. IF ADCITIONAL EVIDENCE IS AVAILABLE, YOL SHCULD SUBMIT IT 6ITH YCJR REGJEST. 00 this certifies that you (or the person(s) on whose behalf you applied), became entitled under the Social Security Act to the. _ t ?arnrity benefits shown. Commissioner A2 Security . _'sxn;t;i.^^:.,:?`"='Et°:11:CSlR•d tBY-.ii1(!!f•7:2t Rlaet:eR?1Q:??' Assessment Committee September 8, 1981 /o oBbo ,2ao 79 (oa l) LAWRENCE GROVEN, SILVER BELL ROAD STREETS -- PROJECTS #274 AND #285 A request of Mr. Lawrence Groven, whose home is on Silver Bell Road in the Wuthering Heights area under Project #285 and Project #274, that he be allowed to have his assessments deferred under the ordinance providing for senior citizen deferral. It was noted that Mr. Groven is permanently disabled and also will, on October 12, 1981, be 65 years old which is a requirement under the age stipulation in the ordinance. Upon motion by Rahn, seconded by Vogt, it was Resolved that the hardship provisions of Ordinance No. 66, Senior Citizen's Deferral, be authorized for the assessments to the Groven property under Projects #274 and #285 subject to compliance with the ordinance provi- sions. All voted yes. ADJOURNMENT Upon motion of Wilkins, seconded Egan, the meeting adjourned at 6:05 p.m. PHH 3 Cities Mai itv Control The following image represents the best available image from the original page. Every effort was made to capture the content from the original page. ? ? 1 f,? k •r ! 3 ?f y?? Y p f t» ?t 4 r ' y f,'#' s??i , .,tTyt.erM'1 rc*K r.zC{f.?"ik d' v.+b',"k` !s}", S +i tip x b ..'4v t 1 r Y h?` 4 1` f vl M4. U ti w + ?L* " ?S. + a., ,.w t )v 4 e.' ?, ,Vp, r+xa N , xr f>. 7'k'° r t r & r t 3 5 ? 5? - '7 iT° k°?'?+" "^Nl??i`fH*' ly ?7 ''S'^' ., `J r u 9 k,. y...,," 'tom. u Jv `" s t ?' ??? l? .1'? S? ,q. *`.. s 1..- a .) ?." uy L ?tik 'Y, r e. n 4"..? ..Ltt"wi '& ?Ir'ar?„ ,, }xi f r d i :3 re e ' ? y°x4'"''g i w < 3. { 5 ) , ,; as ? "r ?*)?.°''uiy.y ' `r4; S ?r? 9 @My+4? 't hY? xay. r r ? ? Sx 1-a f i :"' r .ro n?? <.,aT??MS??hh ?t"Y'ti.Gl?.t"t?$ Y??`4.r?r??IZI T1E4JBIISIC7ESS ?r ?y ?g.'?R'?k??jU? f?ta?73k(?rs? P"Al 7 _ .y?, °eS.?M4iki SrS? f ,l?ql A yYjr=. :y. ,.. <. m,_ .r ai P./"'rhrl3rys 'l?,Asr.`s Aq 3Ty '. Project 274 and 285, Silver Bell Road Streets and Utilities (Iawrerioe "Grover) " T r r?gII}D?A_ {{fi?r„-',? t) FAi a°?Yhh§+ayy'Cp'J?A33?L3?§s Y? iFa1r` R?"?F ,(rs '? ;y i$' L? ^ k'" R.t??'k ?A yu?*x ?Y+n ?t Sxv ?w j .r'' t S? L"l y.: r3 2a.)(F p ?.. 1` 2 1 rye?xw , JsS y, 7a .,.k1?'?J`% $ .:»5"..'L have received a request for special consideration pertaining?to utility Assess- Amts that were installed to the silver Bell Road/wuther Heigh ts area (Pm j ing ? ect '1 X ?•?, , L iIr 11285) with the final assessment hearing being held on July _7, 1981 _,,Under Project ' Mr.' Graven was assessed $3;571.70 for his 97.37 feet of frontage 'for :;the in- . lation of sanitary sewer, wateniai and r ?n`3" ,which has a sdheduled final assessnentnheaz ngfotr September services. 151981 ?J?Gmven .;r? yr is proposed to be assessed $1,821.38 for street improvements on Silver Bell Road 7 for the same amount of frontage. 'As indicated in Mr. -Groven's letter, be has a peiinanent disability'wbich has prevented him fraim being employed since '1978 ; 1.1 addition `cam bctcber 12, 1981, Mr. Groven will be 65 which would qualify him for deferment of special assessments. for senior ei.tizens 'A copy of'. this ord nance is attached for your infornatim.As can be seem, the amount of_ special assessment "for street and utilities does, in fact, exceed the $300 amount stipulated in that + +,grdinance.'"'The average annual payment of principal alone would equal $720, which `" s s ;e?cceeds 1% of the adjusted t gross incame of Mr. Grover -? ?N o:A STAFF' >nMY ?+n itt k r ? tY H? S3} F 1 K xttyt u+a+.y^x f*%'1 } S hMe'?MTION Yr'? h'.??{{ F ? t`'? y i;?'W t• !eH n d? s..? r at'L'? /? r%f $+c a G"' k{r? r. "f??? YC rs?' t° FL ?S4? Di y x tl ?C f rS3 °I ^Based on the amount of assessments levied against Mr. Groven property asa result f Project 285 and 274, a7abined with .the fact of his existing permanent disability and his forthcoming qualification for senior citizen special assessapnt deferment, "' '...'it it the staff's reowmanP?dation that all assessments associated ?ai.th these refer-,,. arced projects be deferred mmt11 such time as stipulated minder the provisicos of. +"; Ordinance #66 r .+ i K7i rp fn xe?11s p+ a/ a ?, i y e y] rsk `t ?y+?p'w?a' `a'?{ ?' `?,?ry'? F' l?.e ) SDsH`s4 ly++M L. v :.Lt-. a k Ah i... .?.?_ V?cti +.r ,'ati? ,ae t; s?? t r N f " i Jt r 1 t M5i ^tt . { ; i 1 aL5 .f1??.)f y f ?%! ? f ?, r .?. Vf y?l'/`. 1 ?'T1: r -} T t Cp e.,n Ceyl w. k 9 ," ?-a '.4 , I` will, 0. J, 7 a1?. 3 ,f pkH L? w jq??5?.-Y e °"-?` t w E'D 5S«, ???i Aiasr J ? ?! ?'4 ?'? ?p ! ?if? ! , llu r { k »'7 up?y,? ?i '4.???+h?' ?C`.-»d 7 3 ,?„?a?ic?A.- ty, ? ft ,a 7. .1 `+? vt? i1 'f`"r x ??we <z?R",!A"Y ?! k? C'" a^.h'Sy Y - ,$ r?''F.? t Y;r? &Y"??r.?r'v'ta r "P 4?'e aTr t... .. .. 'i'4 k.tl . if _. .. ... _? r.. n. '3?XLbdY ... a.?? .? X15=???{ ce u? L e-7) Ati ? V 'A s_ - 71- f 4--c ( ?D D/8'?d dai 7 ? l s 7-12-76 APPLICATION FOR DEFERD04T OF SPECIAL ASSESSUENTS MaER M.S.A.5435.193 P1A4IE: Lawrence E. Groven $ Eunice Groven ADDRESS: 2135 Silver Bell Road Eagan MN 55122 I am not less than 65 years of age, being born on: October 12, 1916 I am the owner of the following described property: Section 18, Township 27, -Range 23. E 97.37' of W 208.7' of 5206' of Government Lot 7 I have the following interest in the above described property: - fee :F joint tenancy - undivided - other (please specify) On January 2, 19 or June 1, 19 63 , I owned and occupied the above property as my homestead and such occupancy began on April. 1963 Special Assessments for public improvements have been or will be levied or. :.;y './ property, in accordnace with the assessment rolls of the City Clerl:-- RE: imp. Project # 274 These assessments would create a personal hardship on my behalf and I respectfully request that payment be delayed until such time as prescribed by Eagan Ordinaace No. 66 To substantiate my claim of personal hardship, I have attached a copy of my 19 81 Federal Income Tax Return. Applicant certifies that all information in this application is true and complet:, to the best of her/his knowledge. DATED: April 20, 1982 410588 D03412 638 GROVEN 1040 _ /? U?® Department of the Treasury-Intemal Revenue Service U.S. Individual Income Tax Return on Su fer to z i 10, Ta not ha he to lount i get-o7 3S offit 11.:.Ota, ity Re nulty and nutty 1 U.S. GOVERNMENT PRINTING Of FICE. 1901-0-343-D57 1981 YOU7_4 ??1 For the veal January 1-December 31, 1981, or other lox year beginning . 1881, ending ,19 OMB No. 1645-0074 Use Yom lire) name mod initial lif joint return, also give spouse's name and Milieu bog name Your social security aumbei IRS LAWRENCE E AND EUNICE GROVEN 472 28 9614 label. Other- Present home addles. (Number and street, including apartment number. or rural route) Spouse's social security no. wise. 2135 SILVERBELL ROAD 471 22 1853 please print City, Iowa Or non office, Sul, and ZIP code tour 'p¢upMA ? DISABLED or type. EAGAN MN 55122 spouse's o<cuwlion ? HW Presidential Do you want $1 to go to this fund? r,e N'p e ng o will o re Election Campaign ? If i oint re . turn. does our spouse want $1 to o to this fund?. r,s xo u n ticreas l not nnease your ua or r<- it- duce v'pur relnna. Filing Status 1 Single For Privacy Act and Paperwork Reduction Act Notice, see instructions. 2 X Married filin joint return (even if onl one had incomel Check only 3 g y Married filing separate return Enter s ouse's social securit no above and full name here ? one box. . y - - - - - - - - - - _ _ p . 4 Head of householdlwith qualifying personl.(See page 6 of Instructions.) It he or she is your unmarried child, enter child's time ? 5 ----------------------------------------- Dualif in widowler) with dependent child (Yearspouse died ? 19 1.(See page 6 of Instructions.) Exemptions X X 6a Yourself 65 or over Blind Enter number o X boxes checked 3 b L_J Spouse 65 or over Blind on 6a and It Always check e First names of your dependent children who lived with you ?_ _ _ _ _ _ _ _ _ _ _ _ _ Enter number of children the box labeled Yourself. ------------------------------------------- p listed on 6c Check other d Other dependents: 12) R l i hi 131 Number of li th d 141 Did dependent h i of IS) Did you provide -hall th f boxes if they Of home at ons p e mon s ve in r name ave ncome 1000 more' an 'pare more o On, 4 ms Enter number unit,_ I apply. of other dependents Add s ed in e Total number of exemptions claimed . . . . . . . . Noes above . . . . . . . . . . . 3 ncome p C 7 Wages salaries 7 , , Imla?'n Stnedple d 11'orer 5100 or ' ' . ' i • 55171 " 8alnterest income You have an Au-Savers Imeresll B ll ease attach B f i y to Dividends launch Schedule 8 if over $4001 py o your . W-2 here. ,rms c Total. Add lines 8a and 8b ac 5 d Exclusion (See page 9 of Instructions) 40 you do not have f 8e 5117 1 00 W- e Subtract line 8d from line 8c (but not less than zero) . 2. see . . . . . . . . . . age 5 of 9 Refunds of State and local income taxes (do not enter an amount unless you de- 9 nsuuctions. deducted those taxes in an earlier year - see a e 9 of Instructions) p g . . . . . 10 Alimony received 10 . . . . . . . . . . . . . . . . . . . . . . • . 11 Business income or (loss)(atuach Schedule C) ? 11 . . . . . . . . . . . . . . . 12 Capital gain or llass)(attach Schedule 0) 12 . . . . . . . . . . . . . . . 13 40% of capital gain distributions not re orted on line 12(See page 9 of Instructions) 13 . p 14 Supplemental gains or IlossesHattach Form 4797) 14 . . . .. . . . . . . . . 15 Fully taxable pensions and annuities not reported on line 16 15 948 .00 16a 16a Other pensions and annuities Total received . . . • . b Taxable amount if any from worksheet on page 10 of Instructions 16b Please , , . att h h 17 Rents royalties partnerships estates trusts etc (attach Schedule E) 17 ac c eck or money . . . . . . . , , . . , , 18 Farm income or (lossHartach Schedule F) ? 18 order here. . . . . . . . Total received 19a 19a Unemployment compensation Insurance) . b Taxable amount if any from worksheet on page 10 of Instructions 19b . . . . , • , , 20 Other income (state namr and sour - ee page 11 of Instructional ?- - - - - - - _ _ _ A IN :• ? L ND R T ----------------- - -- -- -- 20 2660 .00 ------- - ----- ------ 21 Total income. Add amounts in column for lines 7 through 20 . . ? 21 8 7 2 5 Adjustments 22 Moving expense (attach Form 3903 or 3903F) 22 to Income . . . . . 23 Employee business expenses (attach Form 2106) 23 . . . . 24 Payments to an IRA (enter code from pa e 11 24 (See g I - 25 Payments to a Keogh H R 10) retirement plan 25 nstruc lions on . . . . . . 26 Interest penalty on early withdrawal of savings 26 4 page 111 . . . 27 Alimony paid 27 . . . . . . . . . . . . . 28 Disability income exclusion. (attach Form 2440) 28 . . . 29 Other adjustments-see page 12 _ ?- - _ 29 - _ _ _ . . . 30 Total ad ustments. Add lines 22 through 29 . ? 30 491 .00 Adjusted 31 Ad usted gross income. Subtract line 30 from line 21. If this line 15 less man 6 ' ' Gross tneome ,000 see Earned Income Credit Ihne 571 on papa 15 of Irstruciians $1 31 8676 00 , If you want IRS t fi ure our tax a f In tru tl n . ? , . 343-057-1 88 D03412 638 GROVEN • Ifu9eu r? = Page 2 32a Amount from line 31 ladjusted gross income) . . . . . . . 32, 32b If you do not itemize deductions, enter zero 321 If you itemize, complete Schedule A (Form 1040) and enter the amount from Schedule A, line 41 CAUTION: If you have unearned income and can be claimed as a dependent on your 1 parents return, check here ?? and see page 12 of the instructions. Also see page 12 of the Instructions if: you are maffied filing a separate return and your spouse itemizes dMuclions. OR You the Form 4563. OR You are a dual-sinus alien. 32c Subtract line 32b from line 32a . . . _ , , , . 32d 33 Multiply $1,000 by the total number of exemptions claimed an Form 1040, line 6e 33 34 Taxable Income. Subtract line 33 from li?n-?y 32c . 34 35 Tax. Enter tax here and check if from F' Tax Tables. [j Tax Rate Schedule X, Y, or Z, ? Schedule 0, ? Schedule G, or ? Form 4726 . . . . . . . . . . . . . . . 35 36 Additional taxes. Isee page 13 of Instructions.) Enter here and check if from ? Form 4970 36 . [] Form 4972, [] Form 5544, or ? Section 72(m)(5) penalty tax . . . . ..I 7M 38 Credit for contributions to candidates for public office . . . 39 Credit for the elderly (attach Schedules R&RP) . . . . . . 40 Credit for child and dependent care expensesWtach Form 2441) 41 Investment credit (attach Form 34681 . . . . . . . . . 42 Foreign tax credit (attach Form 1116) . . . . . . . . 43 Work incentive (WIN) Credit (attach Form 4874) . . . . . 44 Jobs credit (attach Form 5884) . . . . . . . . . . 45 Residential energy Credit (attach Form 5695) . we .m.. ...._...__ ... _. __ 8430.00 3000.00 3 280.00 280.00 28 48 Self-employment tax (attach Schedule SE) . 49a Minimum tax. Attach form 4625 and check here ? ? 491b Alternative minimum tax. Attach Form 6251 and check here ? ? _ 50 Tax from recomputing prior-year investment credit (attach Form 4255) . 513 Social security (FICA) tax on tip income not reported to employer (attach Form 4137) . 51b Uncollected employee FICA and RRTA tax on tips Ifrom Form W-21 . 52 Tax on an IRA (attach Form 53291 . 53 Ad.,,.. .....w tents 55 Total Federal income tax withheld . 55 56 1981 estimated tax Payments and amount applied from 1980 return 56 57 Earned income credit If line 32a is under $10,000 see W-2, , Page 15 of Instructions . . . . 57 and 58 Amount paid with Form 4868 . 58 it 59 Excess FICA and RBTA tax withheld (two or more employers) 59 60 Credit for Federal tax on special fuels and oils (attach Form 4136 or 4136-T) . . 60 At R._..i_._. ._..___. _ . . . . . . . . . . . . , , Or 63 If line 62 is larger than lin 54 , ,III ce e , enter amount OVERPAID . . 64 Amount of line 63 t b RE 63 o e FUNDED TO YOU . 65 Amount of line 63 to be applied tc your 1982 estimated tax ? 65 66 If line 54 is larger than 62, enter BALANCE DUE A . ttach check or money order for full amount Day - able to "In al Revenue Service."" Write your social securit numb d" 19 1 - 66 be y er an 8 Form 1040 on it (Check ? if Form 221012210F) is attaehee S ease b . ee doe 16 of Instructions.) ? S nle' penrllies of per ury, I declare that I have examined this return nclodiq knowl a i d b gn .: ccom anv e ge and no Schedul! .nice elief it is true, correct and complete. Declaration of prepare r father than landfall is (Lased e g preparer has any knowledge. on and information of Ire L id p son, "pram'. One Spouse s sionature fit tiling ioinuy BOTH most sign even it oniv one had income! reparers s Caere'' a Check it '4mtnre BETTER TAR SERVICE nd Date o preparers social srsaril'/ no. e Only ; ? 220 We 98TH STREET 47 1 34 1055 F.I. no. ? BLOOMINGTON, MN 55420 4 2 zip rode ? 343-057-1 Posting Check List Poaced -..3rd RY_ Date Defoxrcd TaAes!As,essment. Pock _ Tran°s-er Cen: (Red Doi:) Lr^?i ;a.:=o rnr..snt Aises meet Card _ Data t•YOae::siilcR Notified Termination Order Date Terminated l - k, APrIlUITTON AIM AUTKJRIZA.IOH FOR D=vED £AYZ = Or VL,. n. SPE^IAL ASSESSi'iEtTt5 20P. SENIOR CITIZENS' HOMESTEAD LATIS 1374, CRAFTER 206 STATE OF MINtmsOm } COUNTY OF DAtOTA } DATE April 20, 1982 Sb: ::o-anty Auditor, Dakota County, Minnesota It the undersigned, declare under penalties of perjury: That I reaido at 2135 Silver Bell Road, Eagan, MN 55122 That T arA nic :-.han 65 years of age and that the date of my birth is Oct. 12,1916 That i aw the owner of the property legally described as: see attached sheet Property Identification No. 10 01800 021 79 That my interest in the ownership of the above property was squired on April 19 63 and is as follows: C 1. Sole ownership (Enter yes, if applicable) 2. Joint tenancy. held with if, _ 3. Other undivided interest (Specify) That on. January 2, 19 or June 1, 19_6y I owned and occupied the above property as my homestead and such occupancy began on April 191,2 TLat the installments for improvements.on the special assessments duly adopted in ordinance by the City Cn„nz 1 of Fga as of?ey?L 19.21_ which I„ve been allocated against the subject,property would as undue persanal hardship or my behalf and I respectfully request that payment be delayed and that such installment. bo w deferred for the years 19 19_ide;Einite Signed Owner Clark of the of in County, State of Minneso , do hereby certiry at. tiie applicat:oon of )s.aren,s reve.\ above named, has been duly reviewed and that ir accordance with the minixtes of official record in said chambers was duly APPROVED or k as of Soo}e.,..b4r IS 19_. Cy That in accordance with approval granted, the special assessments listed below o: tb. affiants subject property levied for annual collection in the amounts and for the years shown be so deferred with interest at the annual rate shown until such tiraa it is deemed. the applicant no longer qualifies or the property loses its eligibiiit;. Years of Name of Auditors DIP Total. Colllection Interest Asseasrusnt Number No. Amount (Inclusive) R:?a Street - 99 6R1 .G1921 3R S g% Sewer £ Water i.ntc 99 637 T3571.70 1 R% Dated April 20 19 82 VbM OA J 412 ( •k or Authorized Deputy) (over) ' . U. r 2 AS CITY OF EAGAN Remarks r r Section 18 Lot Blk Parcel 10 01800 02/ 79 Addition ! Street 2135 Silver Bell Road state Fagan- MN 55122 7 t , i l 9? ?o ment Pa ceipt Re Date improvement y ! M R 1?11 0( * SEWER LATERAL 1 2 1. U 2 8.11 1 WATERMAIN * WATER LATERAL WATER AREA * Services 1 2 /17 7 1982 O 1 15 STORM SEW TRK STORM SEW LAT CURB & GUTTER _ SIDEWALK STREET LIGHT WATER CONN. 185.00 24404 4-28-81 BUILDING PER. 5 QQ n 25. SAC PARK ;. 1Y H AN I:IUMTON AIM AUTYQRIZA'.ION FOR DELkYM T%A'fM:-IT OF nL: -.,j ¢pF.:'LlL ASSE:&,arfS :OF SF.MOR CITIZL:4S' HOMESTEAD C TWIS 3.?74, MIETM 206 STATE OF MINNESOTA COUNTY OF Wu(OTA ) DATE April 20, 1392 4b: Cvutty Audit-or, Dakota County, Minnesota I, the undersigned, declare ;radar penalties of perjury: Yhat I recida at 2135 Silver Bell Road, Eagan, h1N 55122 That 1' am !,.-t i•:. llnan 65 years of age and that the date of my birth is Oct. 12 1916 `that i as the owner of the property legally described see attached sheet Property Mcncification No, 110 01800 021 79 That my interest in the ownership of the above property was aquired on April 19 63 and is as follows: C ' 1. Sole ownership (Enter yes, if applicable) 2. Joint tenancy- held with 3. Other undivided interest (Specify) That on Janvarp 2. 19 or June 1, 19?g_ I owned and occupied the sbo a psopertY as my homestead and such occupancy began on a„ '1 -- T1Uat the installments for improvements on the special assessments duly adopted in ordinance by the_Ci y ...?;: of t e as of c __19.g" which hwia been allocated against the subject property Would treat's undue personal hardship on my behalf and I respectfully request that payment be delayed and that etch insizaJmont..:M so aaferred for the years 19824flO 19i,,.la rite Signed Z 1 -! r Owner I,.?. Va nwer1oe?? . Clerk of the of n a? a in n County, State of Minneso , do here--y certify at the appIic Zion of Lowren Croeeh above named, has been duly reviewed and that in accordance with the minutes of official record in said chambers was duly APPROVED or WWO as of S ?De r (5 - 19-B-1-- C:11 That in accordance with approval granted, the special assessments listed below cr.: tb- affiants st.;ject property levied for annual collection in the amounts and for the years shown be so deferred with interest at the annual rate shown until such tima it is deemed the applicant no longer qualifies or,the property loses its eligibilit:.. Years of Name of - Auditors D/P Total. Cclllectios Irtrr?st Asseasu nt Mmuber NO. 'Amount (Inclusive) Ltn ????? Srrner Qn 6R1 ° ?r?R R ^ Sewer F. Warrr Inrc Qq 6;7 15 R„ 6V+", ??\? /77g-. 6 a" pa. Dated April 20 19 82 ?Q11t Y ( `k or Authorized Deputy) (over? C I T Y O F E A G A N CERTIFIED LISTING OF POSTPONED SPECIAL ASSESSMENTS LEGAL DESCRIPTION: Section 18 Twn 27, Range 23 E 97.37 Ft of W 208.74 Ft of r? S 206 Ft of Govt Lot 7 COUNTY IDENTIFICATION NUMBER: 10 01800 021 79 POSTPONED SPECIAL ASSESSMENT: Water Area Assessment Pursuant to M.S.A. 429.061, Subd. 2, as amended by the 1980 Session Laws, Chapter 560, Section 5, I hereby certify that the City of Eagan has approved the postponement of the special assessments as set forth above on the property described. bated this -' tk day of T4 V1 IL- 1984 EXEMPT FROM STATE DEED TAX STAMPS This Document Drafted By: City of Eagan 3830 Pilot Knob Road Eagan, MN 55122 Exe t from S ate D ed Tax Dakota County T e urer '?l LOA rU 04 L E. VanOverbe e Ci Clerk/Finance Director Certificate I, E'. J: VanOyerbeke, City Clerk of the City of Eaa, Hereby certi,that-foregoing is a true co ct copE.J VanOverbeke, City Clerk 4 65 .STATE OF MINNESOTJC SS. County of Dakota office of County Recorder This is ' certify that the within instru was filed for record i this 0. n ffluly , on the dayA. D. 19 at 'clock M., and that the-same wecorded in Dakota County Records. JAMES N. OLAN Cou Recorder By Deputy o c c / 7 C ?? ^ :Z           ö ÿ þ ý  ÿ ýý     ûÿÿ öû ìñ ÿ îâüë ëîâí   ù  üûú ùø ÷  ÷ ø÷ ùö  ø ÷  ÷ õ÷üôõ÷ ùõ ûó û÷÷ü÷ öûú÷òöûú÷üô ÿ÷÷ûû÷   ïââí á  áû ÿ þ ýõöíï ëâ ÷éèøüçæ÷ø åäêëêëî øû  üû÷ ÷þéãäêâêíâ  ÷ööõ ù ôó ùù  ÷ûû÷ûúþÙû  ÷÷ ïââí íïüá÷ò ÿ þ õöíïÿ þ õöíí èåëâ ÷ú  þ  á÷   ùù     ó÷  ÷÷  þ÷ù   ùù úü  óõ  ü û  à óÿ þ ð÷  ê ùù æ÷üþ û÷ û üþ û÷ C!ty of Eap 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 (tt.) 5G -9y r Use BLUE or BLACK Ink For Office Use Permit #: kJ/s9 Permit Fee: 96 • L/ /1 —11/-// Date Recei Staff: 2011 RESIDENTIAL BUILDING PERMIT APPLICATI Date: /i'-/) --Jez,' Site Address: ,3?/' 3 Name: J Cx. /.1 &'':°Y.. l� Address / City / Zip: Phone: (, N Unit #: /73 yI Applicant is: Owner Description of work: Contractor Construction Cost: `% Tom-' Gi2t�-�asr:1.,1 Multi -Family Building: (Yes / No i> ) 5— % �74731"01"%ed Cmpany: 62Leib(1 .,t *1. .Contact: n4 (22.S t-7 Address: 6i/) \ 5 4 U /frt , City: c- n 1 L°" State: /lit.. Zip: License #:;,2061:_) y -,,c) c Phone: /1.--3 -%`% Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 6 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: Phone: Phone: Sewer & Water Contractor: Phone: d supporting dorm gay, be = _ ................ rubrit ars you provide spe_. tha.y trade sec: nformatio> could pe 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. 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. x ( 1 s : Applicant's Printed Name nt's Signature Page 1 of 3 Use BLUE or BLACK Ink r For Office Use C, ' Permit (I 1 CRon 411100 j l ty of EaEdI Permit Fee: 3830 Pilot Knob Road I r l Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 i Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 0A _ kA _ Site Address: ~ \ ?J J S \1 c' C Unit Name: Phone: (SIS l ~S cA l c~ J Resident/ Owner Address / City / Zip: Applicant is: Owner Contractor Type of Work Description of work: L C` Construction Cost: Multi-Family Building: (Yes /No Company: Contact: Contractor Address: City: State: Zip: Phone: License 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: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of MI 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.ong 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. Applicant's Printe Name Applicant's Signature Page 1 of 3