4291 Sun Cliff Rd
CITY OF EAGAN ~
3A
10 Pilot Knob Rosd WATER SERVICE PEIWIIT
P. O. Box 21199 PERMIT NO.:
Z~an, MN 55121 ; ; ~ ; D/?TE::
~ No. ~ Units:
Owner: -
Addrosx '
Site Addrcss: r'Plumber.
AM»r No.: y3S6 _ Con
nection Churge:
~ Slze: Acoourrt De
Reoder No.: d~3 ~t'
8 Permit Fee:
1 yme te eo~plf ~!h~ C oi E~~e~ Surchorye;
~ Misc. Chorpes;
B Totol: '
y e Paid:
Dat Irap.:
( ~b
CITY OF EAGAN - - -
3630 Pilot Knob Ftoad WATER SERVlCE PERMT ~
P. 9). Box 21199 PERMIT NO.: ;1
Eagan, MN 55121 ~
Z011if10: P1 D^TE: ~ Owrwr: rr 3 n a C2 3-•s No. °f Units: 1
llddrosx
Site Addresa; 4291 Sun Cliff I'.oad i.I7 I') Sur. Cliff 2nd ~
Plwnber: ~'alle Plu^bin ,
Meter No.:
SIZQ: COII?1QCYlOfl ChOfgE: r .~i~ . 0 0 11 , Reoder No.: ~?coount Depoalt: ~ p.1 I
Permtt Fee; 10.00
I Mn+ to eaeply wft lie C*y of Eoww Surcha
' Ordi..na... rge: .50 d
Mrsc. c?,arges: 1.32.00
a I
i Torol:
BY ~ • meter
Otite of ,nsp.: Date Poid: ~
Insp.: ~
- ------J
CITY nF EAGAN
3830 Pi(ot Xnob Rosd sWER SERVI(E PUMR
P. O. Box 27199 PERAqIT NO.: r 35
' Eagan, MN 551;1
~
Zoninp; DATE; .i- I 1+ - ~ 5 •
pN,r1e,; . ran<. No. of Untts; '
Addrcss:
i Site Addmss: ~ . uA ~a
U'''' _ c At
Plumber. Vs- ey Plumufn€ .
__t
t° M"*"WN' !M pM ef B.!° k,
pn~t~p~, w Cw+NCMon CJweq; 425, 9n
A°oour?t QePotlt:
Rennit FN: r ~
gy Surdwrgo; ~ ,
~ Dote of Insp.; Mlsc. C1nry~
InW: Total:
I Dah Pbid:
.
0-1 CASH RECEIPT ~
CITY OF EAGAN
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE
RCCEIVED
FROM
.n_
AMOUNT $ I i
: r & DOLLARS
loo
~ CASH E],rHFEK
R /
FUNp' - CODE ' "qtnR',1N7
- 7
~
Thank You
IV`~ BY
, White-Payers CoPY
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN 3830 Pilot Knob Rosd, P.O. Box 21•199, Eagan, MN 55121
PHONE: 4548100
BUILDING PERMIT Rece+at # TO w wd fa Est. Volue Date _ o I 9 ti
Site Add?eu Erxt 0 Occupancy
Lot j Blaek Remodel ? Zoning
Parcel No. RmPair ? Type of Consi. 1j,
Enlsryp ? No. Stariss
<; .i Move ? Lsngth 44
~ Name .
N. Demoliah ? Depth
Addresa
Grade ? Sq. Ft.
CitY Phone 4:~ i.. S~ Install O
AMeovah Fisa
~ Name
AU Address Assessment Permit
~ Ci pho~ Woter d. Sew. Surcharye ~
ty : J
Polfu Wan Review, ` -
W I
Narne Fin SI~C ) il
W
U13 Addross Enp. Water Conn.
~ Z.
Cfty Phone Plonrrr Wotar Meter
Councll Rood Unit
I hemby ccknowledye thot I how rood this applicotion ond stats fhat Bldg. Off.
the informotion is corred and ogree to comply with all applicable
APC Total t
Stah of Minnesotc Stotutes ond City of Eaqon Ordinonces.
Ver. Date
Sipnotu?t of Penniftee . ~ _ , a r :.1 { t• ! . , . . . ` ^
A Bufldinq Pannit Is issued to: . on the express conditlon tho+
dl work sholl be daw in atoordante with oll appliwble Stote of Minnesoto Statutes and Clty of EaQan Ordinonus.
BufldirQ Oflicid
~
Pwmit No. Pwnk Holda Dau TNs hoee ik
~~ing
I H.vA.c. Co (A S'(v 3 k
Ebce.ic Co ` ~ ` ~ `
Softonw
Inopection Dsts Insp. Other
Footinp fo~d s /S
Foundation
Fnmina
Roofing
Rough Plbg, ~
Rouyh HVAC
Inwlnion
Final Plbp.
Finsl HVAC
Final i ~ (0 (Z
c.rvoa.
Wabr Oaaibe Locacioe:
Well
tW -
s.w.r
Pr. Oimp.
Receipt MECHANICAL PERMIT Permit No, ~
• CITY OF EAGAN
Fes
Fil/ in numbered spaces S/C
Type or Print legibly Tot. a>•~a
1. Date 2. Installation Cost
3. Job Address''/;'q/ _ fi, '1(Lz r T 4-kot ( ) Blk. I TracY
4. Owner i~~f) 5. Contractor Phone
6. Address /`~iJ~
7. City .JI ? fy r-t_ State 1r) Zip
8. Building Type: Residential ~ Commercial ? Institutional ?
9. Work Description: New~ Add ? Alter ? Repair ?
t
10. Describe Fuel Type
-
11. No. E qu'inment 8TU - M. Ea. No. EQUipment CFM
~ Forced Air Air Handling:
Mfg.
Boilers Mech. Exhaust
Mfg.
Unit Heater
~ Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
;r+•
12. I hereby certhat t above info ' true and correct, and I agree to
I rdin ces ahd rde-a ver i ' type of work.
Signed : tor
Rough f inal
Inspections: Date Insp. Date Insp.
This is Your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
I
Repipt . ~ ~ PLUMBING PERMIT Pennit No.
CITY OF EAGAN
FN ~
; f
- Fill in numbered spaces S/C ~
Type w Print /egib/y Tot
1. Date ~ 2. Installation Cost ~J
. ~
3. Job Address Lot ' Blk. ~ Tract
4. Owner
5. Contractor Phone
6. Address ; < <
7. City State 1~^ Zip
8. Building Type: Residential `El Commercial O Institutional O
9. Work Description: New ~ Add O Alter ? Repair ?
10. Describe
11. No. Fixtures No. Fixtures
i Water Closet Cesspool/Drainfield
4 Bath tubs $eptic Tank
Lavatory Softner
i Shower Well
Kitchen Sink '
Urinal/Bidet Other
i Laundry Tray
I Floor Drains
Drinking Ftn.
Slop Sink
f Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply witl} all ordinances and codes governing this type of work.
Signed 'for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
This eqvest wiO 9 ~ I ~
s~ ~c
B~~G 4 Ce" ~
a Ne9^.es/P D-e c P~re No. Ibuu `ns i I ~
n ~aW Npv,[Y~II Noti(y Insoec-
-l-~ S Yes ?NO lor When /badY
ja'Cicerised Electrical Contractor I hexepy reyumat id,~~ion ot ahove
? Owner eieetriml apark installed at
Sheet Address, Box or qoute No. Ciry
~9 / LLY/ i1e 4co
ection o. Townshi0 /Name or itanpe No. Counly /
4O f 7 R7 l~ ~ ~LLK • ~ ~ ~ L( K d ~
Occu M (PpINT/) Phone No.
rov1C~ cr ~S ~5a "~`J3
Power SupPlier AdUres~s/- .
Elec[rical Con[ractor ICom ny Namgl CmVactor's licause No.
, c~c~ic ,
Maibnq Address (Conuracror or Owner king Instailation)
Autho7ed Signawre ICan[ractor O ner Makine Insblla[ion) NuM~,~r
~ ~0~355
MINNESOTA STA BOARD OF ELECT111CI THI$ INSPECTIOM flFQUFST OIIL NOT
Griqgs-Midwey B dy. - Noom N-191 BE ACGEPYED BY iHE SrAIE BOARD
1821 U mvereity Ave., St Paul, MN 55104 UMlFSS PqOPFA INSfEC710N FEE IS Pnnne 18121 297_2111 ENCLOSED.
G ~ REQUEST FOR ELECTRICAL INSPECTION EB'O00///°~-0°
~ , Sea ir~structions (or co~lati~g this fam m 6eck af ~ellow capv- (95
3,~ 4 4 4 ""X" Below Work Covered by This Request ~
dtl Nep. Type o1 Builtling AppliaKaa Mirsd Equipmnn tired
Home Range Tenporary S¢rvice
Duplex Water Heater Ligfi[ing FixMes
Apt Buildfng Dryer Electric Heatin
Commercial Bldg. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Parm OUx,r ceo Otner ISpedN1
' r u~c,W othe. otne.
ompute lnspection Fee 8elow
p Fee Service trenceSize M Fee Faedars/SU4feetlcrs Y Fee Ci¢vi[s
' Ot 00 m s 0 m30q :tZ' 0 to30 Anws
Above 200 Am - 31 to 700 A~ p' 31 to 100 ngEs
Swinmin Pool Above 700_ Ahove 100_AmPs
Transiormers Irtigation Bonrs c artia L~
Sigis Special Inspection S - /To FtE
Rertarks
44
~
r
Hough-m jatep, :ific Elec
Inspee
Final mrtiTy fhst N.e above
.nsoec4m has bmo
. p S nnde.
Tlhia repueat vol01B manlha trom
CITY OF EAGAN N? 101 8 4
. , 3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
` PHONE: 4548100 t1
BUILDING PERMIT Receipt # 17~~
To M urd fer SF DWG/GAR Est, Value $63,000 Date MAY 6 19 85
SiteAddren 4291 SUN CLIFF R? erect 0 Occupancv R3
Lot 17 elxk 1 Sm/Sub. SUN CLIFF 2ND Remodel ? Zoning Rl
Parrel No. Repair ? Type of Const. {J
Enlarge 11 No. Storiee
rand oaks ^^ove ? Laoe<h 44
~ Neme g Damolish ? Depth Q$
~ qddrass 1881 SUNRISE CT Grade ? sy. Fc.
~ Citv EAGAN phOne 452-8934 1nstau ?
S~E AypeeraM i~as
Zg Nema 0
ou Address Assesament Pertnif '
u~ City Phone Woter 6 Sew. Surchorga 31 . 50
Police Plan Review 161.00
Name Firo 5AC 525.00
~O Addresa Erq. WaterConn. SOO. O
ww CitV Phone Plonnar Water MaMr ~.-Q 0
Council Road Unir 2,90_ no
I hercby ackrowledya tMt I how rcod this applicotion ond state thot gid9. pry, S/G/H S T• P• 132.00
tha inlormotion is corretl and ogree to Wmply with all aOPliwbla
0
Sta1a of Minnesoln Statu es and Ciyy~of E,opan Or Irqncoa. APC 7otel S2,014.5
Var. Date
Sipnaturo of PermiMee
A Bulldinq Permlt Is luued w: GRAND S V L • NT CO m the expros eondition ihat
all work sholl 6e dons In ccco with oll a li bla 5 o Minnewta Statutes ond City of Eaqon Ordinonws.
Buildlnp OffiNol ~
~
CITY OF EAGAN Remarks L~ii/i<tiv>c #/j`639 C24
Addition SUN CLIFF 2nd Lot 17 elk 1 Parcel 10 72976 170 0
owner sereec 4291 Sun Cliff Road state Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF, 91-74 24.62 ZS j,
STREET RESTOR. 4.0,94/078 1986 -2-t5-7-Y3- 431.51 5 /iJ- Y- PS
GRADING / 75,53
SAN SEW TRUNK JS/ 1970 4$ 8-5-8
SEWER LATERAL *
SEWER LATERAL 999 1986 829.62 165.92 5 a9•/oa2: C'-/G 5.~. /G-d'-7-5'
WATERMAIN
WATERLATERAL 1000 1986 942.60 158.$2 5~'/'fo]•
WATER AREA Aal- 19762 3 10 8-
WAT LAT BEN 1942J0>9 1986 57.88 11.58 5 ~ 7. 0 -iU(,S2 /c :l' 95
STORM SEW TRK 1971 161.72 $,Q Z C010$- -g
STORM SEW LAT
S/W SERVICE 1 OS 1986 808.77 161.75 5 81`0S,77 C - /OS.z /u-6-~5
CURB & GUTTER
SIOEWALK
STREET LIGHT
STORM SEW LAT 1006 1986 610.14 122.03 5 (F U,~y -~p& ,1- n,r_01y
WATER CONN.
500.00 n n
BUILDING PER, 10194 ii
SAC
PARK
i
i
0• ~
a. . .
322• +
31 •5+
i51•+
`)25• +
700• +
63 • +
280 • +
132 • +
2007L•5 *
. , ~
,
t
~
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS NUST BE LICENSED ifITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For: ~ Valuation: 3"-Z) Date:
Site Address: (,fa91 A4,-J&OFFICE USE ONLY
Lot: ~ Block ~ Sect/Sub rect X Occupancy ~-3
Remodel Zoning (Z-I
Parcel II Repair _ Type of Const ~
Owner ~ Enlarge _ 11 of Stories
r,.~y0. ~/L Move Length 44_
01 Demolish Depth 48
Address Grade Sq Ft
City/Zip Code
Phone u - APPROVALS
Contractor Zx,~ OGtkj Assessments Permit ~
22. -
Water/Sewer Surcharge a~~.so
Address Police Plan Review (o~ •a
Fire SAC 525•^-`
City/Zip Code Engr Water Conn 5 Do.%
~ Planner Water Meter 63
Phone L~ `7 S L Council Road Unit 2~0.
Bldg Off Parks
Arch./Engr, APC Treatment P1
Address Variance TOTAL C:)
~
City/Zip Code
Phone f1
'EXTERIOR ENVELOPE AVERAGE 'U' COMFUTATION
GRAND UAk::S DEVELdPMENT COMPANY
MODEL 0 AREA U U A AREA
REQUIREll V
1. T07'AL WALL AREA 1800 X.11 198
2. TOTAL ROOF AREA 1196 X.026 31.096
ACHIEVED
AREA U lJ X AREA
A. WINDOW AREA 186.66 .5 93.33
5. DODR AREA 39.8 .077 3.0646
C. SLIDE GLASS AREA 13.44 .48 6.4512
D. rIREPLACE AREA 0 U U
E. WALL FRAME AREA 180 .041 7.38
F. NET WALL AREA 1164.1 .649 57.0409
G. FtIM JOIST AREA 119.52 .0436 5.211072
H. 1=011ND WINDOW AREA 0 t> 0
1. FOUND ABOVE GRADE 96.48 .135 13.0248
3. TOTAL•WALL AREA 189C> 185.5426
J. SK..YLITE U U Q
Y. ROOF FFtAME 119.6 .032 3.8272
L. NET F20DF AREA 1076.4 .025 26.91
4. TOTAL ROOF AREA 1196 30.7372
JUM 1. t2. 229.096
SUM 3.+4. 216.2398
C. R. WINDEN 3 ASSOCIATES, INC.
IAND SURVEVORS Tel 645-8648
Fox: 1381 EUSTIS ST., ST. PAUL, MINN, 55109
896 Z~ OAKS DEVELOPMENT
oc
o (901)
o a,
•
Ln I ~
N i 001 ~ i ~ ~ Scale: 1" = 30'
Denotes Iron
Z Monument
I i ~ p `Y
~955) ~
~y
~ ~(901 p
~ o a ~ ~ \ o
"OLE:
p Denotes Wocden Stake I \ (9
?repesed Garage Floor E1. = 9c)74 ~>n ~/O ~
(907,1 ) Denotes Proposed > ~ ~ 3p • ~
A~ P
Finished Ground El. 29,,
-t-- Deno[es Direc[ion ly
Cf Surface Dzainage
Certical Datum - N.G.V.D. 1929
o
c ~
Lot 17, Block 1, SUN CLIFF SECOND (905.47~ hy
ADDITION, Dakota County, Minnesota
C;v
~
WE NERE6Y CERTIf1' THAT THIS IS A TRUE ANO CORRECi REPRESENTATION Of A SUAVEI' OF TNE
SOUNDARIES Of THE IwND AlOVE DFSCRI6ED ANC OF ?NE IOCATION OF All lUItDINGS, tf ANY,
TMEREON, AN6 All VIStSIE ENCROACNMENIS, If ANY, FROM OR ON SAID IAND
Dorad tAis 2QI dor efAmfli_A D. tV 85 C- R. WINOEN 8 ASSOCIATES, INC
br
Surroyuf, Minnesoro fapiNralion No 7L
.
z/aa
CITY Or EAGAN
APPLZCATZON FOR PERMIT
SEWER AND/OR WATER CON[VECTION
- (PLEASE PRINi)
1) PROPE.°.'L"! ADDRESS: J U/'/ C //T y Fd -
r Frar. DE..-T>TzcN: 1-7 R~ oG t 1 S 41 n i 1~'~ ~11-
(Lot/Bloc}c/S utclvisicn or Tax Parcel I.D. iltsmer)
DA^ 0F Oi2TGiIAi, 'cvILDl`.G ='~:Ii ISSUi\C'_.-':
pcrc,-m ;••.MT'/'r1~OPCSM- US`-': It R-1 SL;GL; rPtiLTLY .
? R-2 DUP= ('IS%O U".IT_S)
? R-3 'IC'.'.-L,II?CL?GE + L':7Z:5) ( II.TZ"'S)
? ic-4 t;c:v;!"D14P/CC_SJCeir;Ij,':1 ( UN IiSi
0 CL1.nE ?CL?I,/F2E.':ATI?Or '
Q L1~L'S i 2IAL
Q .P.dSTI'.^„TIO:]AI,/GGV'E ~N A*.F~'NT
2) APPI.IC•1 (PLEASE FaiNr)
NFU•~: G h~i~~C ~c.~
ADDRESS: /g,fTl . J~GIh I~/S~G' C -
CZZ"!, STA'Iy, ZIP:
PHO-NE:
3) PLL::-'L~E? NPME: lPL`cASE-PR1NI-l.
' r 1e Y 1G~ ~ ( nL _ FOR CITY USE O4LY
/ V
~ ' LUMBERSXICE95E:
PDDRcS~ fal O CCee Attive
CITY, STATE, ZIP: ~O~c10X~ . Expir PY.O~1E~J , - ~ of Retord
PLUMBER LICENSE J{ /
~ G/`~
art tnttta
4) OCCC,mp,~j'I`/Cr,.,~Tm N7kME (PLEASE PR1Ni)
:
ADDF2ESS-
CITY, STA'IE, ZIp: ~
PfinIE _
5) INDICIATE :dHZCH PERi-LiT IS BEZNG RDQUESTED:
1% CO:INFCPION 'IO CITY SEFIER
L+~ COMECi'IC:I 'IO CIT"I WATL'4
? MIER (PLI'1LSE DESCRIIIE)
6) L":D1G~:: C:E: ? PLFaSE E?OID APPP,OVEp PER.'1IT FOR PICs:-LP BY ONE OF A FG7E
ra PT.EASE :•*'.,aZL APPR(7VED PEF:•lIT TJ 11 2, Q, 4 AL-()VE
(Circle one)
7) SZC7,,TUiv.- A DATE:
~ R o1+liM~l~L ~ rl sa l~gata~ ! S nt ~:si-aa ~ s s FSia :a ~ s fR bF~ls~.l~ ~ f~ s/~ S~sYQr e
FOR C I TY U S E ON;,Y
PE?-MIT " ISSUED
R),SE:iLR nEB'1T-T (ISCLDE SURC`.:?P.GZ)
$ /01 5V WAT°R PERMZT (Z.`»CLUDL JURC::AfZGL)
$ WATER METER/COPPERHORN/OUTSIDE REnDER
$ WATE.°. TAP (ZNCLL'DE CORPORATIOV STOP)
$ 5-'.•7ER TAP
$ /.S•~~~ =C~CC::_ ~?GSS_ - c~. 33
$ _ lj, :'_e) ACCOUDIT DFPOSIT - WATER
$ ,eTi9' Wr,C
$ ~ •~i~~ SP.C $ TRliVK WATEi2 ASSESS:?E:iT
$ TRu'z]K SEWE° a55:SS:IEDIT
+S L'nT: P.AL BE:1r.FIT/TRUD]K SE?'.TEB
$ LATcRAL BENEFIT/TRUNK [JAT°R
$ 2,1-~s-0 OT :ER '
$ TOTAL
$ AMOU::T PAI7; RECEI2T
DOES UTILITY CONNECTION REQUIRE EXCAVATION ZN PUBLIC RIGHT OF WAY?
L YES IF YES, THEN A"PERb]IT FOR WORK WZTHIN
PUBLIC ROADWAY" MUST BE ISSliED BY THE
~[39-----'- ENGINEERING ?IVISION. LIST AS A CONDI-
TION.
SliEJECT TO TISE FOLLOWING CONDITIONS: '
APPROVED BY:
TZ:LE: '
DAT ° : /
a1 lsw 101:M w ~ ~ ~m M,=,M slW Mwwomw fil alf@
THE FltONT OF THE WCUM1IEM HAS .4 M1IICR6PRINT AY]OUM BO\ dND THERA[OCHROPIIC A85ENCE OF iHESE FEINRES W ILL INOfCATE d COPY.
WAL*MART'
9,9
SUING
Fllmcjal Sel r l<.Vs (,AGENT ) - "
IMPOPTANT_$EE BAqC BEFORFCg$h!jNG
L0 I
Q j PAY TO THE ,~(~l ~L1 C CZ 1
ORDER OF
~ NOT?
~ 0
OVER?
~ C-.
t 4JE _
PURCHASEP, SIGNEP F F OFAWEfl r}~ 'qm~ _ , I
-1- POPLIN P HY ING V011 AGPEE i0 iN PV ANO OTtlEP iEP'ry5 Crv
.ZV
~n ~t~~ ~i-~~j mr;~'r ~ . - - . - - - - -
Pe able ihm aooRESS ~
s~`c'0eneaea~x ISS U E R! D ER
Fa,roaun,MN TRAVELERS EXPRESS COMPANY, INC.
1:0919005331:544 404L6954~i' 90
I
~ Fo'r`ir5fficei~7`se
Permit
City of Ea~an j #
I Permrt Fee:
3830 Pilot Knob Road ~ ~'7
Eagan MN 55122 ~ Date Received: !-/v I
Phone: (651) 675-5675 Fax: (651) 675-5694 i Staff.i
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: uMC ~
Tenant: a ~ ee 11~ `}Y~~L ee~ Suite
RESIDENT 1 OWNER Name: IVa~ U((I t_ ~ M)'h-r- C?7`~one: 65-j""' 6O9
AddresslCity/Zip:
Applicant is: _ Owner -X Contractor
TYPE OF WORK Description of work:
Construction Cost: (j (?0S/: MWti-Family Building: (Yes_! No
CONTRACTOR Name: A rn'ei'-(" 9 utY0( (-hd rny) _ License#. a1OI Q.3 1?3
Address: aY6 O Rj:~ ,
City: 13ctr~SV. I!Z' State. rn Ohl Zip: 5-533~
Phone. ! 5o,707-6P5 q Contact Persorc
COMPLETE 7HIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7872
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category submined submined
(4 Su6mi55ion type) • Energy Envelope Calculations Submitted
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 8. Water Contractor: Phone:
NOTE: Plan's=and sappoctln`giiocumeRfs thaf you,gubmif are,considered to,be pub/ic infor'mation. Portions of
fhe~inforniation may tie..classified~as~non public`if youprovide specific reasons that would permit the Crty to
. : n,. , . i
=
~ "coriclude'tliaC,tfie ;arefrade:seL~refs: ~ .
I here6y acknowledge that this inforznation 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 appliwtion for a permit, and work is not to start without a permR; that the work will be in
acc rdance with the approved plan in the rase of work which requires a review and approval of plans.
Xi~-P1rQA ~r~ ~a 1l0 ,E'~ x ' ha'm
A~pPIicanYs Printed Name v App icanYs Signature
1 1 ~j~---y~LO $ Page 1 of 3
V ~3