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957 Stanwix Rd ~ ~ CIT{ ~f7tGAN Permit No: ? ~~5~~~ Date: ~ 3830~PIlot Knob Road g~p No; Date: - P.Q: Box 21199 + Eagan, MN 55121 I ~ Owner. ~~t~r,-., 'o,.;~ : i SiteAddress: 957 Stan.~~tx '~c;~-_! " i.e::=::, - _ ; Plumber. nresh~r ! ` • r r ' r MWCC: '~jMniJu Zoning• ~ - ~ City Chg: ,~~Pd No. of Unib: , ~ p zs.~n ~ Acct De : r~nF~ ~ agree to camply wfth the City of Eagan ~ , Permit Fes: ; Ordlnances. Surcharge: - Misc.: gY SEWER SERVICE PERMIT CITY ~F J1~tAN PermitNo: Da~: ~~-Rp 3830 Fdot Knob Road Meter No: ~ S~ 7 g~J Size: o G~ P.O Box 21199 Reader No: ~~T ~,78 6~ Date: s-~ Q~ Eagan, MN 55121 awner. ~~etzo Ct~st:.ars ,~omes Site Address: ~'s7 Stanwix ~'o~~~ T~9 P i Leai g,ton `?q Plumber ' ~ r ~,,,c'~~ Const . `::r n , ~ri~ . s~' Conn. Chg: 5~0. 0~'~~-~~ ur .'2~onin ?'.1. 9~ Acct DeP~ No. bt`P~its: Permit Fee: ` ` ~ , _ _tC. Surcharge: i gr omply wlth the City of Eagan Tr. Plant O Meter. n~ ~ Misc.: gy WATER SERVICE PERMIT ~ . ~ :.e-.=.'~ ~ ~ _ CITY ~F ~EAGAN Permit No: ~ ~ ~ ~ p'~ Dat~ 3830 PHot Knob Road Meter No: Size: , P.Q 8ox 211~9 Reader No: Dat~ Eagan, MN 55121 Owner. ` e~-r~ ",~stor.: '?o:_:~.s SiteAddress: °5~ Stanwix ~oac' r ~n ?'i Lexinrto~~ `'n Plumber.__ Prest r_r Eac/Ol-Pe~^ Const Conn.Ch 5~~`L~~pd ~:1 ! 9~ ,4 ~ . ~ Zoning: Acct Dep: - No. of Units: Permit Fee: 1~' ~~P~ Surcharge: ~ 5~~ I agree to comply with the Clty of Eagsn Tr. Plant ~ • ~»Pd Ordinances. Meter. % ~~~i ~ Misc.: gr ~ WATER SERVICE PERMIT , a~--~v-~.4-• ~ ' + f~'~'`i~ CASH RECEIPT y~ ~ ~ f ~ CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 " , ~ ~~1 . DATE ~ " 19 RECEIVC~ /~t~U' < ~{/7~/'J' j LJ t/~ f/~ [1/)~.. FqOM ~ ~V~ ~-I~/~~~~ -~F 1 u/ I L~. ~ 1G AMOUNT $ "r ~ / ~ ~ & DOLLARS ,ao O CASH CHECK ~ .~LIi~~~~ ~ / ~ ~ ' ~ d~ , t/ ~~,~i~u~-- ~ 9 ~ L ~ • F U ECT AMOUNT Thank You SY ~~-v~-''~--~ White-Payers Copy ~ ~ ~ ~ Yellow-POS~rg Copy Pink~lle Copy CITY OF EAGAN ~ ~ ~ 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ` - PHON E: 454-8100 , BUILDING PERMIT Receipt # ~ % To be used for S'F DiiG/GAR Est. Value ~73•~~ Date 3 ,19 Site Address ~57 ST,ANWIX RQAD OFFICE USE ONLY ?9 3 ~I~Q~ On Site Sewage occupancy R3 Lot Block Sec/Sub, v 7'n1 ArJLI. MWCC System 2oning ~ Parcel No. On Site Welt (Actuaq Const vn W NaRr~g M4TR0 CU$TCIl9 ~~3 jRC City Water ~ (Ailowable) Vn z AddresS ~ PRV Aequired # of Storles 3 ~ Booster Pump Length 4~ ~ City~ n~ Phone ~+~-~g83 Depth 4b , o Name SAl'1~ S.F. Totai ~ 4 AddreSS Footprint S.F. ~ City Phone APPROVALS FEES ~ ~ Engr./Assess. Permit ~ ~ ~ ,~W Name 36.50 ~ Planner Surcharge Address Q W City Phone Council Plan Review ~~3.~ Bldg. Off. SAG, City 1~+~ I hereby acknowledge that I have read this application and state that the Variance SAC, MWCC S~•~ iniormation is correct and agree to c~ ply witk'~II applicahls-$tate of Water Conn. ~t_~ Minnesota Statutes and City oI E~" r.g~fi'6rdirtaRSe6,.. ^ ~ Water Meter `5ignatureofPermittee ~ ~~~r•` - RoadUnit 325.~ r~r~a ~irs~ro~ A~Building Permit is issued ta: Treatment P1 Z~+~ on the express condition that all wark shall be done in accordance with all Parks ~p~icable State of Minnesota Statutes and City of Eagan Ordinances. TOTAL ~ ~ Building Official CITY OF EAGAN ~ ~ ~ ~ 3830 Pilot Knob Road, P.O. Box 21-199, Eagsn, MN SS121 PH ON E: 454-8100 BUILDING PERMIT Receipt~ To be used for ' Est. Value ~ ' ~ ~ Date ~ ` ,19 ~ 1 ~ OFFICE USE ~NLY Site Address :1 f.',7 r'~ On Site Sewaga Occupancy Lot Block ~ Sec/Sub. r'/~. MWCCSystem Zoning ~ Parcel No. On Slte well (Actual)Const ~n ' j N(; City Water (Allowable) ~ a Name W ~ . PRV Required # of Stories ; Address ~f City ~ Phone ~ Booster Pump Length Depth , o Name S.F.7otal ~ ~ Address Footprint S.F. ~ City Phone APPROVALS FEES . l,~j h , r,(, ~ ¢ Engr./Assess. Permit F= Name Planner Surcharge S~ _ - Address ~ Z Cit Phone Council Plan Aeview ~W Y .~0 Bldg. Off. SAC, City ti 'in .'~Q I hereby acknowledge that I have read this application a~d state that the Variance SAC, MWCC ~ information is correct and agree to comply with all applicable State of WaterGonn. Minnesota Statutes and City of Eagan Ordinances. ~ Water Meter 7'~ SignatureofPermittee - RoadUnit ~2S•~ t1:~I1+1: t;r~•~~e,.. TO1+4.00 A Building Permit is issued to: Treatment P1 on the express condition that al I work shall be done in accordance with al I Parks ~ applicable State of Minnesota Statutes and City of Eagan Ordinances. TOTAL Building Official Permit No. Prrmit Holdsr Dat~ T~lephone ~ Plumbin ' ~ s 9 .-J ~ ~,1~/"-G~' H.af.AC. 1~ ~ ~ c1 ,ti, , ~ ~ Electric „ i ~ ~ ~ ` Y~ Softener Inspection Date losp. Comments Footings I Footings II Foundation Framing ~ ~ Roofing Rough Plbg ~ Rough Htg. _3r~ Isul. Fireplace Final Htg. ~ Final Plbg. ~ Bldg. Final ~ Cert Occ. Temp. LP Deck Ftg. ~ g ps Deck Final 3 ~ . Well Pr. Disp. ' 1 ! . . . . _ ' ~~yj . ~ , . . f~~rti#ir~t~e ~nf (~rru~~nr~ . ~itp of ~agan ~p~m~ ~ .~~r~~ This Certificate issued pursuan~ [o the require~nenu of Section 306 of the Uniform Buildrng Code cernfying that at the time of issuance lJris structure was in compliance with the various ordinances of the City regulating bailding construction or use. For the faIlowing.• _ , Vae G1aui6cation ` Hldg. Pormit No. T' : ~ t?• : ~~r Tra zo~oe o~a;a ~yy~ c~u. " f ;;,"it~ CIla1LM : ~.Y. ~ S P.O. nL1Y, 1(i~', , : rc: Owner of &tilding Addraa t tm BufWitl6 AdAteas r - ~'t*f a~'l. ~ . . t.l.~~ ~ ~.J ~1vC, ~.~w f i i: .<r~ '1.3. nu•: a,7a;~ oes~ POST IN A CONSPICUOUS PLACE . . . . PERMIT # ~ ' • ' ' " MECHANICAL PEHMIT ~ . CITY OF EAGAN RECEIPT # ~X 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE PHONE: 454-8100 ~ite Address BLDG. TY E WORK DES RIPTION Lot ; `f , Bloc}c ~ Sec/Sub Res. ~ New r ~ Name Mult Add-on Comm. Repair ~o Addre c City Phone - ~her FEES ~ Name ` ~ RES. HVAC 0-100 M BTU -$24.00 c Address - ~ ADDITIONAL 50 M BTU - 6.00 O City f'`+' ~r J~ ` n Phone (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PERMIT) - 1.50 EA. TYPE OF WORK COMM/IND FEE - 19~6 OF CONTRACT FEE Forced Air ~ M BTU APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE 8 CONDOS - RES. RATE APPLIES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8~ Unit Heater M BTU REMODELS - 12.00 Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00 Vent CFM $ STATE SURCHARGE PER PERMIT - .50 Gas Piping 0utl~ts ~ BE1' ND $1 opp) PERMIT PRICE GOES Other FEE: ~ S i • 1 ~•f ~r ! ~ • . S/C: S G ATURE OF PER ITTEE , •.i TOTAL• 'K ~ FOR: CITY OF EAGAN . . ' . PERMIT q ~ ^ ~ ' ' ' PLUMBING PERMIT l- CITY 8F EAGAN RECEIPT ~k U~~---%-~ 3830 PILOT KNOB ROAD, EAGAN, MN 551Z2 DATE: CONTRACT PRICE: PHONE: 454-8100 ~ : - % Site Address ~ ~ BLDG. TYPE WORK DESCRIPTION Lot ~ T_ Block ~ SeciSub Res. New ~ ~ ' r`~ Mult Add-on Name~ ~ ~ - Comm. Repair m ~ Address ~ ~ Other c City ~ • t Phone RES. PLBG. ONLY - COMPLETE THE FOLLOWING: - NO. FIXTURES TOTAL Name ~ ~'r ~ ~ 1v~1F ~-~ater Closet - $3.00 S ' _ ~ ~_Bath Tubs - $3.00 c Address ~ ' ~ ` 1 Lavatory - $3.00 p City ~=-!f , ~ ; , ~ i . Phone ~ ~ Shower - $3.00 - ~Ki?chen Sink - $3.00 ~ FEES UrinallBidet - $3.00 COMM/IND FEE - 19~b OF CONTfiACT FEE ~_Laundry Tray -$3.00 APT. BLDGS - COMM RATE APPLIES ~Floor Drains -$1.50 TOWNHOUSE & CONDO - RES. RATE APPLIES Water Heater -$t.50 MINIMUM - RESIDENTIAL FEE - $12.00 Whirlpool - $3.00 MINIMUM - COMMlIND FEE -$20.00 ~Gas Piping Outlets -$1.50 STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMI~ (ADD $.50 S!C IF PERMIT PRICE GOES Softener -$5.00 BEYOND $1,000.00) Well - $10.00 • Private Disp. - $~0.00 / , TRough Openings - $1.50 SIGNATURE OF PERMITTEE FEE: • : STATE S/C: FOR CITY OF EAGAN GRAND TOTAL: CITY OF EAGAN nJo 14 6 5 8 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 , PHONE:454-8100 ~j ~ BUILDING PERMIT Receipt# ~ ~B J Tobeusedfor SF DWG/GAR Est.Value ~~3,OOD Date~~ ~CH 3 1988 Site Address 957 STANWIX ROAD OFFICE USE ONLY Lot 29 Block 3 Sec/Sub. LEXINGTON SQUARE OnSiteSewage Occupancy R3 7TH ADD. MWCC System X zoning PD ParcelNo. OnSiteWell (ActuapConst Vn METRO CUSTOM HOMES INC Ciry Water X (Allowable) Vn c Name - W P.O. BOX 1049 PRV Required # of Stories ~ Address o C~ty B' VILLE phone 454-9383 Booster Pump _ ~en9th 47 Depth 46 , o Name Sp'ME S.F.TOtal ~Q Address FootprintS.F. a City Phone pppqOYALS FEE5 ~ w Engr./Assess. Permit ~ 466.00 w w Name ~ i Planner Surcharge 36. 50 i - Address Cit Phone Council Plan Review 233.00 a W Y Bldg. ON. SAQ City 100.00 I he~eby acknowledge that I ha~e read this applicaiion and state that the Va~iance SAC, MWCC 550.00 information is correct and agree to co ply ~ II applica 9tate of WaterConn. .~59 .QO Minnesota StaWtes and City o Water Meter 67.00 Signature of Permittee Road Unit ~?J'~...~0 A Building Permit is issued to: METRO IISTOM OME$ Treatment P7 204.00 ontheeapresscondition a[allworksha betloneinaccordancewithall applicable State of Min, ot Sa tatutes d Cit Eagan Ordinances. Parks Lli~~-. TOTAL $Z,531.50 Building OffiCial ~ 3 This request void~/~1/~~ / 18 ~ron[hs from <~1~ D 94' 127 ~ I~~ ~ ~J~ ~~~oo fle i st Da~., Fire No. FouAh-' nspecli Repu ~Ready Nuw ~iW+IT'Notify InsOec- . ' ?N ~ lor When ReadV censed Electrical Contraclor I herebv ~epuest insoaclion of ebova ? Owner eiactricel work ins~alled et: St ~ Address. Bo. or ute No. Cl~v ~ ecuon o. Towns~i0 Name or No. Range No. County u~t IPR~TI Phone ~ Pow Olier Atldress Electnc 1 CoMracior 1 o pany I ~ Cnntractor~s Licen~e No. y~~,~;Yu~,~ ~~j~~f" Maili Atldress ICunVa or Owner M/~inp Insta' tionl ~ S . Authorized Sipnature (Cont dctodOwner Making Installaiionl Phone NumOer THIS INSPECTION NEpUEST WILL NOT MINNESOTA STATE BOAPO ~i ELECTNICITY Griggs•MiCwey Bide. - Aoom N•797 BE ACCEPTED BY THE STATE 80AND UNLESS PXOPER INSPECTION FEE IS iB21 Unive~silv Ave.. St. Paul, MN 55104 Phone(6721642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION ea-aoooi-os ~ See instructio~s lor complatinB ~his torm on beek o~ vellow copy. ~,~~+J/ 9 412 7~~x ~ Be~aW Work Covered by Ihis Request eC. (,Gl-Heo. - Tyoe of BuildinB Aao~~nncea Wirod Equiument Wired - Home Range Temporary Service Duplex Water Heater tiny Fixiwes Apt. BuilAing Dryer Electric Heatin Commercia~ Bldg. umace $ilo UnloaAer Industrial Bidg- Air Conditioner Bulk Milk Tenk Farm Nx~ oeu v .~nar ISOeulyl t .r Sueci(y ther Olher omn~~te lnspection fee Below N iae SarviceEMrance5ixe p Fee Feaders~5ubleeders N Fex Circoits Oto200Am s Oro30Am s Otn30Am s Above 200 q~nps 31 to 100 Amps 31 to 100 qm s Swimming Pool Above 100-Amps Above 100_Am~s Transiormers Irrigation Booms Partial~"Other Fee Signs Special hispection SG~J 0 TOT E Ae~rks '0 No~eh-in D~Le ,the EI ' . . ~ ~r~ Insaector. herebv /J certily thet the above iinal , ` ins0ection hes been ~ea. mb requast voia 18 moNhs Imm 2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION ~ ~ ~ I ~ City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Plcase complete for. single family dwellings & townhomcs/condos when permits are required for each unit Date / / ~ / SiteAddress -`~l ~ ~~~V ~ l~~• Unit# Property Owner ~ ~ ~/l ~/CVl~~~i Telep6one # ( t(/~a ) cY ~ SO ~l Contractor ' / Street Address ~"1~ City ~ ~(/(iC. State ~ ! Zip >Telep~one ~t ( ) ~l "7 Bond k: L/l ~`~~d U O~ , Expires: The Applicant is _ Owner ~j'Contractor _ Other Add-on or alteration to existing dwetling unit $ 30.00 furnace _Additional _Replacement air exchanger airconditioner _New ~teplacement other StateSurcharge ~~5 $ .50 Od ~ MAY 4 ey $ ~7J Totat ` ~ 1 hereby apply for a Residential 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 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. i~s r~~ ~ ~~J~ ~ Applicant's Printed Name Apphcant's Signature I I 2004 COMMERCIAL MECHANICAL PERMIT APPLICATION City OfEagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please comple[e for. commercial/industrial b~ildings multi-family 6uildings when separatc permits are not required for each dwelling unit Date / / Site Street Address Unit # Tenant Name (if applicable) Previaus Tenant Name Property Owner Telephone # ( ) Contractor Street Address C~~y State Zip Telephone # ( ) Bond Expires: The Applicant is _ Owner _ Contractor _ Other Work Type _ New Construction _ Underground Tank _ Install _Remove "see below _ Interior Improvement _ Install Piping _Processed _Gas Nature ofWork: '"When insfaUing/removing underground fank, ca!! for inspection by Fire Marsha! and Plumbing Inspector PeCmll FPes: 57~.50 Undergroimd tenk instailationhrmoval $50.50 Mittimqm (includes State Surcharge) or Contract Value $ x 1% _ $ Permit Fee • If ep rmit fee is $1,000 or less, add $.50 ~ $ State Surcharge If eo rmit fee is over $1,000, add $.50 for every $1,000 eo rmit fee $ Total Fee 1 hereby apply for a Commercial 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 this is not a permit, but only an application for a permit, and work is not to start without a permir, that the work will be in accordance with the approved plan in the case of work which requires a review and approva] of plans. Applicant's Printed Name ApplicanYs Signature Approved By: , Inspector Date: c~ ~~g~ ~ 2004 RESIDENTIAL BUILF~NG 7•ERMIT APPLICATION City OfEagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 . _ New Consiruction Reauiremenls Remodel/Fiepair Reauiremenis 6tficetJse Onh1 3 registered site surveys showing sq. fl. of IW, sq. fl. of house; and £II roofed areas 2 copies of pian ~ Cert oFSurvey Rectl Y ~~y (20% mazimum b~ coverage allowed) 1 set of Energy Calculafions for heated addi~ions 7re2 P~~s Pf9n Recd Y.,_, N' 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks TrBC PresRagUUed Y,,,,,N lsetofEnergyCalculations Addifion-indlcateifonaitesepticsystem UtrsileSgpfic5ysiem .~_Y _N 3 copies of Tree Preservation Plan if lol platled affer 7l1/93 Rim Joist De~ail Oplions selection sheet (bldgs with 3 or less units Q Q2 Date /JCIR / Q~ Construction Coat -1 ~ O J I Site Address Q S~ S~-0.v1WWk ~G~ . Unit/Ste # Description of Work n 4 C.l Sl f~(~~~5 L~J / i V~ ~ Multi-Family Bldg _ Y_ N Fireplace(s) _ 0_ 1 _ 2 l+~n o M~ ~.,r~ , . Property Owner~ n ~ ~ ~`~1 FC. Telephone # ~Q ( o~) lQ ~(O - ~ga ~ RMA HOME SERVICES INC. Contractor Home Depot Installed Sales Address 3200 Cobb Galleria Pkwy., Ste. # 200 Atlanta, GA 30339 State BG20268257 ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category , Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (J submission type) Submitted Su6mitted • Energy Envelope Calculations Su6mitted Have you previously constructed a building in Eagan with a similar plan8 _ Y _ N If so, 25% plan review fee applies. Licensed Plumber Telephone ) Mechanical Contractor Telephone ) Sewer/WaterContractor Telephone#( } I hereby apply for a Residential Building 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 the State of MN Statutes; I understand this is not a pemut, 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 pl~n in the case of work which requires a review and appr al of plans. L/2~ ~ Applicant's Printed Name A plicant's Signature OFFICE USE ONLY ~ ~ Sub Types ? 01 Foundation ? 07 O5-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 O6-plex ? 16 Fireplace ? 21 Porch (&sea.) ? 31 EM. Alt- Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garege ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Att - SF ? 04 02-plex ? 10 OB-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Starm Damage ? O6 04-plex ?'12 12-plex P~bg_Yor_N ? 25 Miscellaneous Work Types ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ?.44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement ~ 'Demolition (Entire Bldg) - Give PCA handout to applicant Valuation Occupancy MCES System Census Code Zoning City Water SAC Units Stories Booster Pump # of UnRs Sq. Ft. PRV # of 81dgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS _ Footings (new bldg) _ FinaVC.O. _ Footings(deck) _ FinaVNo C.O. _ Footings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ F[gs _ Air/Gas Tests Final _ Framing _ Siding _ Stucco _ Stone _ Brick _ Fireplace _ R.I. _ AirTes[ _ Final _ Windows _ Insula[ion _ Retaining Wall Approved By: , Building Inspector Base Fee Surcharge Plan Review MClES SAC City SAC Utility Connection Charge S&W Pertnit & Surcharge Treatment Plant License Search Copies Other Total 4 R ~ y_ ~ Installed p~,~-~o,~eser+? Siding and Windows ' LIMITED POWER OF ATTORNEY , . , _ , 0 COUNTY OF COBB STATE OF GEORGIA KNOW ALL PEOPLE BY THESE PRESENTS: THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania ("Principal"), and a licensed contractor of RMA Home Services, Inc., DBA Home Depot Installed Sa1es loca*.ed at 660 Mendelssohn Avenue North, Golden Valley, ~VIN 55427, having a license number of BC- 20268257, do hereby appoint, name and constitute Elder-Jones Building Permit Service, Ina ("Agent") as my true and lawful attorney-in-fact and do authorize and grant said attorney-in-fact for me and in my name, place and stead the power to execute, acknowledge, sign and deliver (in such form as may be required by the municipality) a permit application, or any other instrument(s) which may be necessary aud appropriate, in order to obtain the proper permit(s) from the City of Eagan, Minnesota for the installation, maintenance and regair of windows and siding (the "Work"). The powers conveyed to the Agent by this Limited Power of Attorriey are limited solely to the express powers.delineated herein and apply solely to the Work. This Limi*ed Power of Attomeyshall expire and automatically be reyoked on the 21st day of May, 2004, which date is one year from the execution hereof. Further, the powers conveyed by this Limited Power of Attorney may be revoked by Principal at any time by express revocation and shall also be revoked by the Principal's death, disability, incapacity or incompetence. I?~? W£'I'NESS WIIEREOF this Limited Po~uec of Artorney is e.xecirted this 21 st day of May, 2003 ~ ~ David . Katz SWORN TO AND SUBSCRIBED BEFORE ME by David N. Katz on this 2l st day of May, 200~ ~`f~~ ~ Notary P icin forthe State of~Georgia A1y Commission Expires: January 21, 2006 396816.v3 ' Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor. 3200 Cobb Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 • Fax (770) 984-0709 • Toll free (800) 79-DEPOT RESIDENTIAL /o~ aS 'S.~-a ~ 6 BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 851-881-4875 New ConstruetMn ReaulremeMS NamoAeURena~r H~ulremeMs • 3 regisleretl sae surveys showing sq.1t. U bt, sq. k. of house; antl pll roofed areas • 2 copies of plan (20% maximum ht covarage albwetl~ ~ 1 set at Energy Ce~ulatlons tor heated atltlRbns . 2 copies of plen showing beam & window s¢es; poured (ound desgn, etc J • 7 slte survey tor e~derbr add8lons & decks • 1 set of Energy Ca~ulelions • InAicete'rf home served by septic system far additions • 3 copies ot Tree PreservalWn Plan ~ bt pletled aNer 711/93 . Rhn Jolst Detail Optbns seiectlon aheet (bldgs w~h 3 or less uniGa) DATE ~ I'-t I FJ O~ VALUATION ~~5~~ SITE ADDRESS `1~ rI~C iLl L MULTI-FAMILY BLD6 _ Y '~N NPE OF WORK~~ /v ~1:~ ~l~ I I~L~~ ~rQQP , FIREPLACE(S) _ 0_ 1_ 2 APPLICANT 1 C~O~~ STREET ADDRESS CI STATEJ V~ i~ ZIP ~ 1 l~1 TELEPHONE I"~D~~~~ELL PHONE # FAX # GiJ I" U1"l O~I K~ PROPERTY OWNER ~ J W ~ ~ ` ~ ~ ~ l,l, TELEPHONE # ~SJJ I " l~fC~3 COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Enargy Code Category _ MINNFSOTA RULES 7670 CATEGORY 1 MIN " f "t'~'-'_t submission type) . Residential VeMileNOn Category 1 Workaheet Submiried • Ne _ ~@eY.~ubmifted . Energy Emelope Calculations Submitted ~~I I~ JUN 0 5 [uuL I;;; ~ Plumbing Conhactor: _ ~ Phone # Plumbing system includes: _ Water Softener _ Lawn Sprinkler .$94:00"" Water Heater _ No. of R.I. Baths No. of $aths Mechanical Conhactor: Phone # Mechanical system includes: Air Conditioning Fee: $70.00 Heat Recovery System Sewer/Water Conhoctor: Phone # I hereby acknowledge that I have read this application, state that the Information is correct, and agree to comply . with all applicable State of Minnesota Statutes and City of Eagan inances. SignatureofApplicant~~~ ~ .........._._...-°-------'.___.---°--°--°°----........._...Y._.._..~_......-..~.r. OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4/02 OFFICE t1SE ONLY ? 01 Foundation ? D7 OSplex ? 13 1Gplex ? 20 Pool ? 30 Accessory Bidg ? 02 SF Dwelling ? 08 OB-plex ? 16 Firepiace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multt ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF O 04 02-plex ? 10 0&plex ? 18 ~eck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm ~amage ? 06 04plex ? 12 12-plex Plbg_Yor_N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 AddiUOn ? 36 Move Bldg. Q 42 Demolish (Foundationj ? 45 Fire Repair ? 33 Alteretion ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 WindowslDoors ? 34 Replacement •Demolitlon (Entire Bidg only) - Give PCA handout to applicant Valuatioa Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bidgs Length Fire Sprinklered Type of Const W idth REQUIRED INSPECTIONS _ Footings (new bldpJ FinaUC.O. _ Footings (deck) FinaUNo C.O. _ Footings (addition) _ Plumbing _ Foundation HVAC _ Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tesu _ Final _ Framing _ Siding Stucco Stone _ Fireplace _ R.I. _ Air Test _ Final _ Windows (newheplacement) _ Insularion _ Retaining Wall Appraved By , Buiiding Inspector Base Fee Surcharge Plan Review MGES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total ~ ` ' ~ • 1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN SINGLE FAMILY DWELLINGS ~ ~ V INCLUDE 2 SE'TS OF PLANS, 3 CEftTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS NOTE: ADDRESSES FOR CORNER LOTS - CONTAACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. MULTIPLE DWELLINGS AENTAL UNITS FOR SALE UNITS 41 OF UNITS INCLODE 2 SE'I'S OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.~ 1 SET OF ~NERGY CALCULATIONS CObA1ERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS To Be Used For: 7' Valuation: ~TL'1i~ Date: cZ a9 Site Address 9S7 ~~:A~~l-LJ_T Ild h OFFICE USE ONLY 13~ 0~0 Lot B1ock ~ On site sewage_ Oecupancy R~ 3 MWCC system ? Zoning p D,~ Parcel/Su ~ i~• On site well Actual Const V-N City water ~ Allowable V-NI Owner PRV required _ Il of stories " Booster Pump _ Length ~/7~ Address J~'O /d~e~~ / 0 1~9 Depth ~F 6' S.F. Total City/Zip Code ~/./.4,u.,,,..~L1~SS337 Footprint S.F. Phone -S~~S '~-9 4d 3 APPROVALS FEES Contractor Engr/Assess Permit ~/C~,00 ~1 , Planner Surcharge ~~,50 Address j'(~_U.C~. io~9 Council Plan Review ,Od Bld$. OFf. SAC, C1ty ~ 00,00 City/Z1p Code~i ..,4ls S.S-33 7 Variance SAC, MWCC .SSD,00 Water Conn 550 ~ LY~ Phone ~{Sg~- g a~ ~ Water Meter 67, OU ~ ! Road Unit ~ OU Arch./Engr. ~~fia ~~~~~f~iu[~+ Treatment Pl 2~ DU I Parks Address ~Q ~-C~ ~9 Copies TOTAL ~,531.50 City/Zip Code Y~L%a .~...aA/, ~SS~ ~ 7 Phone lk rys~{- ~S~ ~ UqLI.IATIbtiI / ~ GARAGE ' • ` ; zz~tzz.= ~18y ~IK3 ~2 `17L xl~{ = G~og 8~s--~N~- i3 x,3~. - 468 x ?9 = zoy 67? x 13 ~ SBo I I-!DU 5~' 3~ X z y = $6Y X~l= 40 2d X /2 ~ Zc/o 'ZXG= l2 '2KG+~' 12 1168 x y9r S'123Z ~Zbyl ME7R.o ,C'vsro~rl /-JomES El B E . 74 0/ COHSULTIHO EH6IHEERS ~NG1NEEi~ING ~ P~AF+?+EAS ond lAHO ~UAYEYOQS COM(~f~NY, 1NC. ~ 1000 L157 146ih 57AEET, BUftN:vILLE, uINHE507A 5~337 PII 4~2-3000 C~7"~Z~Z CLZ~e 4~ V~+ZrL~"'Y'e ~~~a1 .I~e.scr~~~~ian: GoT z9, BLOCK 3, LEX/N6ToN SRuAR~ 7TN ADDITiON, DAKOTA CnuM7Y~ /141NNE5oTA C$B~.~L~ DENOTES ~X~S7/~v6 ~LEI/fIT~aN (889.7) DENdTE$ PFZOPo$ED ELEI/~4T/dN /NDlCATE.S D/R~CTIOnt OF SURiACE ORA/NA6E 89a.oo = F/N/SHED GARA6E Fl~dR ELEVAT/oN (s7e,4) (sis,-4) ~ ~ ~ s az D E ~879.0 • . /67. 75 1 (B79.o) ~ / ! L./ ~~I ~ ~ ~ / ~ J ~ ~ ~ Lo~T 2 9 a ~v . DRAlNA6E AND UT1L/TY EASEMENT / ~ c- ~ t`~et ~ ~ ~ C~S~) ~ \~oa'~ ~ S, ~ ~ ~ fa_sie~ ~\'s ~ O c \ \ ~~~R2o6R9~ C885.~j g~ o~9N~~ ' 3. ~ ~ \ ~897. ''b Q° \ ~ C ~ . Q9 ~ o ~l ~ ~ ~ r?~ 3 N~9 'V' n J ~ \ W~i~~ k).1~'a~0. y0 ~J / ~1 \ ^ s \888 ~1 ~ ~y B' u .y '11 ~q0 ~ a31 -0. \ 1 0 s~'~ ~Q; . ~ ~ve ; ti'O ~ ° ~a s • oo po ~ 9' 5\ / 3~1~~ $CAf~= .30' FRO/VT BU/LD/N6 ~'o y9~g° ~~7.4) SETBf}CK GINE ~ (sai zj ~ L D 5'~~~~ (ee`~.7 ~ Q- ~ ~ ~aaaes) I her~by cartify that thia ia a i:ue and correct repreee~ntation of a tract of land as ahoxn'and deacribed hereon~• As prsParnd by mn on this r9~ - day ot f~~~~~y ; ~98g, . REV1~~~ 3~~~88 ?~viSFA BAR. RsnM etEK . ~ ~ ,r~ Ninn. ltea. No. ~~oe~ ~ Y ! - 1989 BUILDING PERMIT APPLICATION - CITY OF 6AGAN ~ - 5INGLE FAMILY DWELLING3 ~ C~ ~ ~ ~ INCLUDE 2 SETS OE PLANS, 3 CERTIFICATES OF 3URVEY~ 1 SET OF ENERGY CALCULATIONS NOTEs ADDBESSES F~R CORNEH LOTS - CONTRACTOR/HOMEOWNER MU3T.D£.SIGNATE WAICA ADDRFS3 IS DESIRED. NO CEiANGES WILL BE ALLOWED ONCE BUILDING PSAMI'f I3 I330ED. MULTIPLE DWELLINGS RENTAL QNITS FOR SALE UNIT3 / OF UBITS INCLUDE 2 SETS OE PLANS, CEHTIFICATE OF SURVEY - CHECK WITA BLD(3. DEPT., / SEf OF ENEHGY CALCULATIONS CO[R,fERCIAL INCLUDE 2 SBTS OF ARCHITECTURAL & STHUCTUHAL PLANS, 1 SET OF SPECIFICATION5 AND 1 SET OF ENERGY CALCULATIONS MAR 1 3 1989 To Be Used Fors i~e~~ Valuation,~~~ 1Yate: gy Site Address 4~ ~ ~r~'~~~~ /~flo OFFICE USfi ONLY Lot z y Block 3 Oceupanoy F$~ Zoning Parcel/Su6 L~1~/~~ f~ _ Aetual Const Bldg. Permit /L Allowable Surcharge •.S~ Owner .s~c ~7 ~q~jf,~ S # of stories Plan Aeview Length SAC~ City Address 9 5~ ,sfjf s~J wi Depth SAC, MWCC S.F. Total Water Conn City/Zip Code ~~yoZ~ /'?~z` ~S~Z~3_ Footprint S.F. Water Meter ~ Aect. Deposit Phone ~~Z- 35~3 On site sewage_ S1W Permit On site well 3/W Sureharge Contractor/~i'y'~~ J/j.S~'f MWCC System _ Treatment Pl. / City water Road Unit Address Z~a~7 ~~KS L~'j PRV required _ Park Ded. Hooster Pump Copies .S'o CityfZip Code ~/~/~'~u~ Sryy7 20TAL a,uu APPROVALS Phone 5.~3 - 9~ ~7y Planner _ ~riyinal bli~~. ~ern~i~ Couneil f~rC{-itJQ+,~,. Ch~k Arch./Engr. Bldg. Off. ~3~~[E. ~ Varianee ~1~=:5 lL;ed ~D~10y }Dr Address ~ ~ 4 Z~ City/Zip Code Phone ll NOTE: Sewer & Water Permit fees and aecount depoait fees xill be ineluded in the building permit fee. ProceBSing time for sewer and srater permits is tao days once a lioenaed plumber has applied for a permit at City Hall. ME~en ,C'usTOm /-Jo«iss p' . , # i~74: ai n~~~ G411S,UlTiH6 ENOINEERS ENGINEfiflING ~ p~n?ir+Ens nnd LAH~ 3unvEVOns COM(~I~NY, INC. ~ 1000 FJ15T 146~ STREET, BUfiNSVILLE, ~INHESOIA 5~337 PII 1=2'3000 C~e y-~` Z~Z C cz ~ e o~ S~~" ~r'e ~ ~,~4,4j Y.tcr~f~~ZOrL: LOT 29, BGOCK 3, LEX/N6ToN S6UAR& 7TH AaDlTlON, DRKOTA CauNTY~ I1~INNESoTA C~~~L~ DEN4TE'S EX157/N6 ELEI~AT~aN (&89.'7) DEN~TES PROpogEO E'LE~ATIUN /NDIL'ATES D/REC7/Ont OF SUFZFACE DRA/NR66 89a.oa = F/N/SHED GARA6E FGOVR EL~VAT/~N (g>a.4) ~ i~-r feie,q) ~ ~ - s sz ~ ¢S E ~g79.o . /67.75 ~ (8'79.0) . , 1 ~ ~i,` ~i ~ / ~ t' ~ '7P • l___OT 29 ° ~ ~~6 pl~JlNA6E AND v71 L / ~"Y EASEMENT . ~ / ~y / \ c~ R \ ~ \ • j? , ° ~ R, ~BSj~ \ ~.n '?n . ~ y~ ~ \ ~87.g~ ~ s ~ ~ . ~l~) ~2O ,6\~ (885.~ 4. o 'O N3~~ ' \ ~s~~ ~ Csai~) g''"µ'!~~1¢~'~~ ~ ` \ N V"" 'OJ~ ~/aONP : V ~ ~ ~ K' ~ \ ~ Q, ~ ~0.. 3„ ~B, Py1~ S ?.~O' ~ ~ba~1 \88_ eo a,~`~~~'.~ °qq0. ~ 61~31i ~ I L:~,7Y' ~ ~ ~ `v: l ~b ( I~ ,i+aQ ~ io l`3~ ~P5 \'L ~ ° ~o ~1 ~,{n ~ ° ~i$'~ 1 1! / 31 ~ 30' FRONT Bv/c.D/n~b h9~a~ P v~ ~~~.a) gCAGE ~ 4° ~ SETBR CK L/IJE (ae`z z j ~ e D y'~ ~o~` ~egj z> ~ ~ ~ Ces~be) I her~by cartify ihdt thie ia a t:ue and corrsed b~pme~ontthi~~ /~'jn~...~d+Ycatof ~and as ~hoxn'and deecribed heraon.• pTQp y r~EV~~r.r:, ~`~rzev4rr ; 19 eg„• ev~seo e.vx. ~a er{v. ~ No. /Go~~ 3/-/ea ~ i~~. , ~.~•...~,.t }tinn. ~a~ ~ a ; '4'" LOT BLOCK ~ SUBD. a`f~ ~ 7~ RECEIPT # ~ ~ ~ C ~ DATE ~ / ~ ~ ~ ~ 0 ~ 1996 CITY OF EAGAN IRRIGATION PERMIT (FOR BACKFLOW PREVENTER) COMMERCIAL INSTALLATIONS: FORM MUST BE COMPLETED BY LICENSED PLUMBER Date: `-~'e~-~n~~~ /~I~/(v _ Commercial GPM _ Residential (boulevards) GPM Existing residential Area/address to be irrigated: ~3 ~v~~X ~ J Installer: ~C~/~ ~ ~~W~~ Owner_L~ Pl~umber ? Street address: ~ ~ ~ ~~~G rt ~vl:~ ~r% City, state & zip code: i i9~-~2i . i~i' 5~/ Z~ Phone ~5 ~~Yy~ i Owner Name• h~~5~ £ ~~~/FF~i ~a~r°~2 5 Streetaddress: 9s ~ ~5~~w~X City, state & zip code: F~Crf7vv /il~ ~z 537 z~ Phone '7 S~- ~~y ~ irrigaiio~ wniracior, if uifie~eni inati insialier: Telephone 1 hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances. It is the applicanYs responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement. ~ - ~ L~ Ci u.,~.i~1 Applicant's signature Title Approved by: Date: PRV ? Yes ? No New service ? Yes ? No Meter Size & Cost S~ Fees due: ~ Calculated by: j i v y~ r,~ 1~,~~ ~ ~~c~._~~ ~ J,3 ~ PROCEDURE FOR IRRIGATION SYSTEMS - 1996 An irrigation permit j~ required - please contact Protective Inspections at 687-4675. Fees Commercial project: $25.50 irrigation permit to cover installation of backflow preventer. $50.50 water permit fee only if new service is installed. $300.00 per tap if installed by City. Residential project: $20.50 irrigation permit to cover installation of backflow preventer. $50.50 water permit fee if new service is installed. $760.00 ner connection - WAC. $396.00 ~er connection - water treatment facility. Existing residence: $20.50 irrigation permit to cover installation of backflow preventer -(not required if backflow preventer previously installed). Meter charge: If gallons per minute are less than 25, a 1" meter will be required at a cost of $182.00. If gallons per minute are more than 25, a 2" turbo with strainer will be required at a cost of $822.00. This information is to be supplied by the designer of the system. No meter will be sold before all sewer and water inspections are complete on a new service. If new seroice lines are not re~uired, one check may be written for meter and permit costs. Receipt will be coded to 20-3716 (meter portion only) with pink copy forwarded to Utility Billing Clerk. The installer is to contact Protective Inspections at 681-4675 for inspection of the inside water line and backflow preventer. The Public Works Department may be reached at 681-4300 for water turn-on and set • and seal of the meter. Inspection hours are 8:30 a.m. to 3:30 p.m. Monday through Friday. Requests for A.M. inspections should be made on the preceding work day. Requests for PM inspections will be accepted until 12:00 noon. ~ ~ , APFLI~ATION FOR PERMIT pAYMFNf OF FEE AT TIME OF s^ ~ ~ APPLICATiON DOFS NOT CON- : ~ ~ SPIILTIE APPRGVAL OF PIIthffT. y ~ SEWER AND/OR WATER CONNECTIQN * I"~°~''`0C1 oF s~ ~/ox "mTm r : irs~rawwrzoczs wIIa. Nor se sc~ ; k LTIlII. PERbIIT WLS BEa1 APPROVm. x ~ . • . a+++~**+rr.rrrtxti~e~W~~~er+~exa+r+werur+r ~ ' Ci~~ OF CC6c~C9~1 ~ (PLEASE PRINT 1) PROPERTY ADDRESS: . . . ,Q.t f. . /4-r?G~.I.C X Q ' - - i'MY;AT' DESCRIPTION: ~ ~ a q. . . ,(~L. ~ . _ ~ ~ 4. . ~ - ~^Lot Bloc Su vision or ax Parcel ID IF EXISTING STRL'CP[7RE, DATE OF ORIGINAL BUILDING PII2MIT ISSOANCE: Mon Year PRESENT ZODTING/PROPOSID DSE: Q COPM'fE[tCIAL/f2ETAIL/OFFICE ~ R-1 SINGLE FAMILY Q INDDSTRIAL ~ R-2 DL~PLEX ('iwn Ljnits) Q,INSTIT[.'TIONAL/GOVEF2~E,TIT ~ R-3 4'OWNHOOSE (Three + Dnits) ( Lnits) Q R-4 APARTMENT/COI~IDOMINILM ( Units) . 2) ~ NAME: ~QE.f~i~~£/.a. GXC ADDRFSS: ~0.(S !S.¢~owr..~ C2 ~.~J CITY, STATE, zIP: ~ p~t F Uq t ~ E/~ l ~ l~ ' S~S / 1~ PHONE: 3.2 -F~ ) ~ S~ For City Cse 3) NAME: 8 L'- Q E2 G C Or?S T Pl rum~e s License: ADDRESS: o o - 3/ f`r ~T T • Expired y~ . Not recordec CITY, STATE, ZIP: pe.E ~,~t LEY PHONE: !F Z~- 96 ? 9 MASTII2 LICENSE # 3 G q,! /i'I 9 St Iaf n~itl~al 4 ) ~e'~~diP71~'a o .i~ a~: V~IET2o ~~425 ADDRESS: PO Q6X ~~'I~`I,,~ CITY, STATE, ZIP: QK,~„rsv,=i~F ' PHONE: ~S~ ~-9 ~ 5) s a • a~~ ~m ~ CONNECTION TO CITY SEWER ~ CONNECTION TO CITY WATER Q OT[~RR 6~ ~4,...~ ~-~1~ *****~*******~.~*****~~*******~*******~~~~~****~********„********************~**~******~*~~********X ~ * THEE GOLD COPY OF THE PERNIIT WILL BE SENP ~IRDCI7,Y TO PUSLIC WDRKS ZO FACILSTATE METER PICK-UP. ~ * PLEI~SE AISAW ZSVO WORKIN~ DAYS FOR PROCE'SSING. SOb9FANE FROM Tf~ CITY WILL CONi'AGT 7tOfJ IF 1Y~12E # * ARE ANY PROBLENIS. + ~«~*********~***+****r+~****++**~***++***~~*****~*********************:*****~****+******+*~***+**~*y • ~ L . ~OR CITY USE ONLY ~ PERMIT # ISSOED ~ !.f'/~2 , . Pd w/Bldg. Permit FEES: ' $ S ~D-~~ SEWER PERMIT (INCLODE SURCHARGE) $ S /D-S~ WATER PERMIT (INCLUDE SORCHARGE) /f~ ~ ~ S WATER METER/COPPERHORN/0('TSIDE READER $ $ WATER TAP (INCLL~DE CORPORATION STOP) $ S SEWER TAP $ /S ~ D ~j ACCOUNT DEPOSIT - SEWER $ S /5 •J d ACCOONT DEPOSIT - WATER , $ a` SD -CJ'~ S wAc S C~D~~ s sac $ $ TRL~NK WATER ASSESSMENT $ $ TRC~NK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ S LATERAL BENyFIT/TRLNK WATER $ o`~ o $ WATER TREATMENT PLANT SLRCHARGE $ S OTHER: $ f-'-Y/~i(UO $ ~J~~L~D TOTAL ~ ~ar3~F RECEIPT RECEIPT DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PL~BLIC RIGHT OF WAY? Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN PDBLIC Q ROADWAY" MLST BE ISSL~ED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY; ~~~~~J ~T~J~°uo TITLE: DATE: ~/2~/'~d