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2125 Wuthering Heights RdCITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road O B 21199 P PERMIT NO : ox . . . E ' an MN 55121 DATE: , oning r[+?pb its. 1 1 t 1 r: j, r%, 4 l Site Address: t' ie ' i?`rLs 'ai , Pjumber: fTQ -el c t - - - Meter No.: 3460 0 G p.! Size: Account Deposit: 15 . 00 pd Reader No.: n S 6 Permit Fee: 0 ° 00 p`? 1 else to empty whh the City OF seven Surcharge: *?d ordi Charges: Misc . Total: Date Paid: e InsP.: + Insp.: - - --- - - TR IM CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Poad P. O. Box '' 1199 , PERMIT NO.: Eagan, MN 55121 DATE: Zonina: ' No. of Units: 1 t'etlnealy Address: - ber: r No.: Connection Charge: r, ' 7>d 1 ' Account Deposit: !er No.: Permit Fee: n ee to empty with the City of low" Surcharge: "me" Misc. Charges: > MC' Total: Date Paid: of Insp.: Insp.: TY OF EAGAN 30 Pilot Knob F?oad 0. Box 21199 gan, MN 55121 to empty wish the City of asses SEWER SERVICE PERMIT PERMIT NO.: } DATE: ' - - r; 4 No. of Units: 1 Connection Charge: Account Deposit: _ Permit Fee: Surd rae: Dote Paid: By Misc. Charge:: Date of Insp.: Total• CITY OF EAGAN Remarks ei = I" Addition Section 18 Lot Blk Parcel 10 01800 020 78 Ownerir, Street 2125 Wuthering Hats Road state Eagan, PIN 55122 ???_ W„-i?Yar?no 1+,-rr pli 53ia? 13=2g9' /4 Improvement Date Amount Annual Years `gr Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK ya 1968 $148.75 $4.96 30 PAID * SEWER LATERAL 1982 5989-55 399-30 1 5989.55 C010013 1-29-85 WATERMAIN • WATER LATERAL 1982 15 1 WATER AREA -144 1977 $402.80 $26.85 1 ,15 A015134 2-5-85 s Services 1982 15 STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 470.00 #48152 12-6-84 BUILDING PER. SAC 525.00 " PARK d4wjul(?, /? • 9;0 /?. 9o 14v`- F/ r- F .-L is -0 1O1.a , s 3 f 01 Receipt PLUMBING PERMIT Permit No. CITY OF EAGAN Fee e- Pill in numbered spaces S/C F Type or Print legibly Tot. 1. Date -?/`ljcz`' 2. Installation Cost 3. Job Address Lutht!v I Lot Blk. Tract 4. Owner i ., ;: •f ,".> > x ' 5. Contractorkl Phone J 6. Address-_-)G 7. City <- State zip 1 8. Building Type: Residential 0 9. Work Description: New ? 10. Describe 11. Commercial ? Institutional ? Add ? Alter 0 Repair ? No. Fixtures Water Closet No. Fixtures Cesspool /Drainfield Bath tubs Septic Tank Lavatory Softner Shower Well Kitchen Sink Urinal/Bidet Other [,4t:A/ Laundry Tray Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. 1 hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : for Rough Final Inspections: Date Insp. Datez Llytnsp. A629_ This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 CITY OF EAGAN 3795 Pilot Knob Road No. Eagan, Minnesota 55122 INSPECTOR NOTIFICATION Phone: 454-8100 REQUIRED BY LAW ,spat= PERMIT FOR ALL INSPECTIONS Date: Receipt No.: Single -t ierir - ?P_ Site Address: { cllt Residential J? Lot Block (?' Sub/Sec. - -' Multi Res., Comm./Ind. Nome New /Alter./ Repol r Address Cost of Installation C City Phone: Permit Fee Name Surcharge Address City Phone: I Total This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official CASH RECEIPT CITY OF EAGAN P. 0. BOX 21-199 EAGAN, MINNESOTA 55121 DATE 19 RKCQIVZO ' FROM - i -f AMOUNT Is 6 DOLLARS Leo - ? CASH 0 CHEC FOR FUND CODE AMOUNT r jjLfikYou BY 1 White-Payers Copy Yellow-Posting Copy Pink-File Copy i CASH RECEIPT CITY OF EAGAN $. O. BOX 21-199 EAGAN, MINNESOTA 55121 DATE % 19 RECEIVED i/ FROM AMOUNT $ I & DOLLARS loo ? CASH ? CHECK RO FUND CODE AMOUNT / r Thank You BY f White-Payers Copy Yellow-Posting Copy Pink-File Copy EAGAN TOWNSHIP BUILDING PERMIT )wner ----- 4?[t%`.t!,''.5..../ '0 t.../.?.....-'------- ..--- .ddress (present) ..?./.:.....L.....?.... wilder ....-----:...?....1 .. ...............................°--------- .ddress ---------------------------------- ....------------- ------ DESCRIPTION M 1012 Eagan Township Town Hall Date .................... Stories To Be Used For Front Depth HeightI Est. Cost Permi! Fee Remarks _ _ -tv A) LOCATION $tr Description of Location Lo! Block Addition or Tract This permit does no au o e e use of streets, roads, alleys or sidewalks nor does it give the owner or his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT 9N THE PREMISE WHILE THE WORK IS IN PROGRESS. This is to certify, that ------ ?.-. .. --------- ........has permission to erect a----- ......--. ..---- ...... upon the above described premise subject to the pr isions of the Building Ordinance for EaTownahi adopted April 11, 1955. ......................... --'- .......... of ............ Tnwn ............ Board Sui..........._. Per ....... ................ (/????. //;?_?///?rx"? Chairman ."'Y.._.---. .ld...i. 9.......p..ecto." ...r n Ins 4-106- ' (Q RESIDENTIAL BUILDING Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements RemodelfReoair Requirements Office Use Only 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cart of Survey Recd -Y -N (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pies Plan Recd -Y -N 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Reqd _ Y -N I set of Energy calculations Addition - indicate B on-site septic system On-site Septic System _.Y _N 3 copies of Tree Preservation Plan if lot platted after Vi/93 Rim Joist Detail Options selection sheet (bldgs with 3 or less units Date r,, 3 d Construction Cost Site Address /7( en r wci ? b Unit/Ste # Description of Work G Multi-Family Bldg - Y ?AN Firepl ace(s) - 0 - 1 2 Property Owner ?e7 G 4> - cow /3 & j / Telephone # (AIW k5-'k- Q 7n? Contractor 20? Address City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (J submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. Licensed Plumber 0elephone # Mechanical Contractor Sewer/Water Contractor 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 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. Applicant's Printed Name Applicant's Signature CITY USE ONLY PERMIT RECEIPT DATE: 2002 RESIDENTIAL MECHANICAL PERMIT APPLICATION CITY OF EAGAN 3$30 PILOT KNOB RD i l?(p a j e j2 EAGAN MN 55182 651-6$1-4675 Please complete for: ? single family dwellings townhomes and condos when permits are required for each unit Date: (? /[ 'FA SITE ADDRESS: i n e?1 Hl:E OWNER NAME: ? ' l /`C Cd' bct?_TT INSTALLER NAME: STREET ADDRESS: 7402 Washington Avenue Eden Prairie, MN 55344 CITY: 941.1044STATE: Place a check mark next to the permit work type TELEPHONE* TELEPHONE #: ZIP: _ Add-on, modification or alteration to existing dwelling unit $ 30.00 • furnace replacement • air exchanger • air conditioner • other M U / D Nature of work: Pe a Xac- e Fc-ci,- lUl 0 2 2002 zg= ( C- B State Surcharge $ .50 Total $ 30 S? IG ATURE OF PERMITTEE 1/02 f i 2/84 CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION (PLEASE PRINT) 1) PROPERTY ADDRESS : , 7?/- j LEGAL DESCRIPTION: _'_. jy?c /0-0I17DLD-07.0 --7'? (Lot/Block/Subdivision or Tax Parcel.I.D. Ntunber) IF FtIS __'C STRL "2 --- 0= O_ - -.T "=?,G PU=iT IS'::i•;C=.: _3 PRESENT SONIIX/PROPOSED USE: R-1 SINGLE FAMILY D R-2 DUPLEX (TWO UNITS) ? R-3 TOWNHOUSE (THREE + UNITS)( UNITS) ? R-4 APAPTMENT/CCNCOMINIUM ( UNITS) ? COMMERCIAL/RETAIL/OFFICE ? INDUSTRIAL ? INSTITUTIONAL/GMUNMiP 2) APPLICANT (PLEASE PRINT) NAME: ??h2RS 611)FV.4z ADDRESS: W711- ?d CITY,, STATE, ZIP: G[??lG?? PHONE: i 3) PLUMBER Nom: PLEASE PRINT) NY? FOR CITY USE ONLY ...-_.__. ._-__.._..__. PLUM S LICENSE: ADDRESS: 300OKENNEBECDRIVE, EAGAN, MINN. 56122 Active CITY, STATE, ZIP: 452.1565 Q Expired . MASILR Q Not of Record PHONE: PLUMBER LICENSE N 001445M2 a nitia 4) OCCUPANT/(7wNER NAME: ADDRESS: CITY, STATE, ZIP: PHONE: 5) 6) INDICATE ONE: PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE PLEASE MAIL APPROVED PERMIT TO 1, 2,C3; 4 ABOVE (Circle one) 7) SIGYATU'RE: ?,(f / J? ?-?at?-- INDICATE WHICH PERMIT IS BEING REQUESTED: © CONNECTION TO CITY SEWER Q CONNECTION TO CITY WATER C] OTHER (PLEASE DESCRIBE) DATE : /, 5 ` +O re.?;?.s. ,,e E.e ?.a? ?.t syt ?+id.?.? hr ?r ?i.4 a!+n¦ , i!+k ?k - F O R C I T Y U S E O N L Y J PERMIT ISSUED j FEES: $ SEWER PERMIT (INCLUDE SURCHARG E) O_ S-d WATER PERMIT (INCLUDE SURCHARGE) $ G "? WATER METER/COPPERHORN/OUTSIDE RE D A ER $ WATER TAP (INCLUDE CORPORATION STO P) $ SEWER TAP $ ACCOUNT:DEPOSIT - SEWER $ ACCOUNT DEPOSIT - WATER o $ SAC $ TRUNK WATER ASSESSMENT TRUNK SEWER ASSESSMENT $ LATERAL BENEFIT/TRUNK SEWER $ LATERAL BENEFIT/TRUNK WATER $ OTHER -.w ..- ..... $ / o?S' c-rJ TOTAL $ ' M T A OUN .P,AID/RECE.IPT?:14 DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? YES IF YES, THEN A "PERMIT FOR WORK WITHIN _ PUBLIC ROADWAY" MUST BE ISSUED BY THE NO ENGINEERING. DIVISION. LIST AS A CONDI- TION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE : ? ssr rur ram:04 alum mm skm MUM am m 9.* ?w 4P;14 m w? rE? rE Sr ?rt+ sE? see mum „ ...... /o o(0- 0 6 0Zo -7 8 BEA SLOMOUIST MAYOR THOMAS HEDGES CITY ADMINISTRATOR THOMASEGAN MARK PARRANTO JAMES A. SMITH THEODORE WACHTER COUNCIL MEMBERS April 27, 1981 MARY KENNEALY 2125 WUTHERING HEIGHTS FOAD -MN-55121- CITY OF EAGAN 3788 PILOT KNOB ROAD w EAGAN. MINNESOTA = 98122 " PHONE 454-BIW \piK{ tt EUGENE VAN OVERBEKE CITY CLERK Re: Parcel 10-01800-020-78, Project 285, Special Assessment Deferment Request (ordinance #66) Dear Mrs. Kennealy: On September 30, 1980, you submitted a letter to the City requesting that the City defer your assessments under Ordinance #66. Your request was presented to the Special Assessment Committee at their meeting on March 31, 1981. Based on the in- formation submitted, the Special Assessment Committee recommended approval of your request for deferral of the assessments under ordinance #66 with the condition that a formal application be submitted and all items of compliance be adhered to. This recommendation was reviewed by the City Council at their meeting on April 21. The City Council officially concurred with the recamendation Of the Special Assess- ment Committee. Therefore, I am enclosing a formal application for deferent of your assessments from Project 285 under Ordinance #66. Upon receipt of a caTpleted application form and the copy of your most recent income tax statement, we will pro- cess this deferment request providing that all conditions have been met. If you have any questions pertaining to this, please feel free to contact me. /Sincerely, Thomas A. Colbert, P.E. Director of Public Works TAC/jac cc - Ann Goers, Special Assessment Clerk enc. THE LONE OAK TREE ... THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY. y -RECEIVED i"Ai' i U I-?i APPLICATION AND AUThnRIZATION FOR DELAYED PAYMM OF T?U' ON SPECIAL ASSESSMENTS FOR SENIOR CITI=-NS' HOMESTEAD LAWS 1074, CHAPTER 206 STATE OF MINNE30TA ) COUNTY OF DAKOTA ) DATE 19 To: County Auditor, Dakota County, Piinnesota I, the undersigned,' declarepn?/unnder penalties of perjury: That I reside at That I am n:?t less than 65 years of age and that the date of my birth is. That I am the owner of the property legally described as: fury 8? -7 a3 ._ v Property Identification No.. 4W /O (TiCa 7 p ? ?0? ?©d b ?? ? That my interest in the,.ownership of the above property was aquired on Vu4- 19 ? and is as follows: 1. Sole ownership (Enter yes, if applicable) 2. Joint tenancy, held with 3. Other undivided interest (Specifv) That on January 2, 19 Z a or June 1, 19 97on0 I owned and occupied the above pro erty as my homestead and such occupancy began C? GY / 19 05 F That the installments for improvements on the special assessments duly adopted in ordinance by the City of_fa _as of 19 which have been allocated against the subject property would treat undue personal hardship on my behalf and I respectfully request that payment be delayed and that such installments be so deferred for the years 19_3]_ to l9_UUknCWn Signed Owner I, E S • Je bO\6., Clerk of the - : -t of C0. Qh County, State of ILnnesot do hereby certify at the in Uo. lL.ia application of t? Mns\y above named, has been duly reviewed and that in accordance with the mutes of of ial record in said chambers was duly APPROVED or BB as of 4 -P2j 19-E?-. That in accordance with approval granted, the special assessments listed below on thr 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 time 4s it is deemed the applicant no longer qualifies or the property loses its eligibility Years of Name of Auditors D/P Total Colllecticn Interest Assessment Number No. Amount (Inclusive) Ra<::e Dated Mernh 29 19-u_ (over) kow CI Pni;Hi:a ix?nty Posting Check List . F Council Minutes April 21, 1981 1. Eugene F.aeq -- Project #241, Dodd Road. The Special Assessment Committee recommended no change be granted in the assessments. 2. Fred Pietsch _ Project #241, Dodd Road. The Assessment Committee recommended that, because of financial hardship, that the assessments be postponed for one year with reconsideration being given to future postpone- ments at that time based upon additional information on the hardship. 3. David Matasovsky, Proiect #299 and #304 -- Northview School Area. It was recommended by the Assessment Committee that the staff proposal be ap- proved with the understanding that it is not intended to be a precedent and that assessments be cancelled until such time as connection to the Eagan sanitary sewer and water lines take place which assessments would be levied at the rates then in effect. 0G()91 4. Ernest Schirdeldecker, Project #254R and #316 -- Safari Estates and Galaxie Aver.ue. The Committee recommended approval of the deferment of the existing and pending assessments under Ordinance No. 66 regarding sewer and water trunk area assessments for Safari Estates and pending assessments for lateral benefit from sewer and water under Project #316 covering Galaxie Avenue. 5. L. J. Parker -- Project #201, Cliff Road. It was recommended that no adjustment be made to the trunk sanitary sewer area assessment levied to the L. J. Parker property on Cliff Road. 6. Mary Kennealy, Project #285, Wuthering Heights utilities. The Assessment Committee recommended the assessments against the Mary Kennealy ,property for utility improvements to parcel 02078 be defered in accordance with hardship provisions under Ordinance No. 66. 7. Don Warkentien, Project #304, Schmidt Addition. The committee recommended that the north 150 feet and the west 160 feet be eliminated from trunk area consideration and lateral benefit for trunk assessment rates with the understanding that the southerly 215 feet of lateral benefits and trunk -water main be assessed in addition to installed water service in the assess- able area used to calculate the trunk area water assessments would be defined as the easterly 500 feet of the southerly 215 feet of parcel 03176 covering approximately 2.7 acres for assessment purposes. 8. Trudi Johnson, Project #241, Dodd Road. No recommendation was made by the Assessment Committee with the request that the staff further explore the possibility of adjusting assessments based upon grant of storm sewer ponding easements. 9. David Gabbert, Proiect 0261 and #301, Ches Mar East 1st, 2nd and 3rd Additions. It was recommended that Mr. Gabbert's request for a 15 year time period for assessments rather than five year time period for Ches Mar East 1st, 2nd and 3rd Additions be denied. 9 /a 0/boo PLO 7t III. NEW BUSINESS H. Mazy Kennealy - Project 285 (Wuthecing Heights utilities) - Ordinance #66 - Deferment FACTS Sanitary sewer and wateru ain facilities are presently under construction under Project 285 providing public utilities to Mrs. Kennealy's parcel located at 2125 Wuthering Heights Road (Parcel 020 78). The pending assessment against this parcel amounts to $5,766.00. The estimated average annual Payment assuming a 15-year spread at 11% interest would equal $722.71. Because this assessment exceeds $300.00, verification of the age criteria and financial hardship would have to be verified by the processing of a formal application form accompanied by the most recent Federal Income Tax Return indicating the adjusted gross in- come. During the acquisition of easements necessary to provide sewer and water to adjacent property owners, it was assumed that i4ary Kennealy would be able to meet this ordinance requirement. Subsequently, she dedicated the ease- ments with the understanding that the assessments would be deferred under ordi- nance #66. STAFF'S RECOMMATIONS If a formal application for Ordinance #66 is submitted indicating that the finan- cial hardship exists in accordance with the ordinance and that the age criteria has been met, it would be the staff's reanmendation that this assessment should be deferred in accordance with ordinance #66. 36 September 30, 1980 Eagan City Council Eagan City Hall 3795 Pilot Knob Road Eagan, MN 55122 Re: Improvement Project #285 Dear Councilmembers: I have been dealing with the Eagan staff for the acquisition of a utility easement across my property north of Silver Bell Road. I am requesting under Eagan Ordinance No. 66 that the City Council approve a deferrment of my assessments under the Senior Citizens clause on the following bases: 1. That the property which will be assessed for these utility services is my homestead property. 2. That I am over the age of 65. 3. That the total acreage that I own in the area is less than 10 acres. 4. That the proposed assessment exceeds $300. 5. That the hardship for me includes the fact that I cannot further subdivide my land and that the assessment is excessive in light of my retirement income. With the understanding that the City Council will approve my request, I am signing the utility easement covering the permanent easement for the Silver Bell Road area water and sanitary sewer project. Very truly yours, Mary Kennealy 37 PAUL H. HAUGg & ASSOCIATES, P. A. ATTORNEYS AT LAW 3909 SIBLEY MEMORIAL HIGHWAY EAGAN (ST. PAUL). MINNESOTA 55122 PAUL H. HAUGE AREA CODE 612 BRADLEY SMITH - October 16, 1980 TELEPHONE 4544224 KEVIN W. EIDE Mr. Thomas A. Colbert Public Works Director 3795 Pilot Knob Road Eagan, MN 55122 Re: Silver Bell Utility Easements Dear Tom: I am enclosing a letter signed by Mrs. Mary Kennealy and submitted to the City of.-Eagan under Eagan Ordinance No. 66 -- Assessment Deferrals. In my limited investigation it appears that Mrs. Kennealy is in her late 80s and that all other ordinance requirements would apply. I would appre- ciate your submitting a letter executed by Mrs. Kennealy to the Eagan City Council or Assessment Committee for appropriate action and further that we be notified as to the result of Mrs. Kennealy's request. Very truly yours, Kevin W. Eide skk enclosure cc: Ann Coers Joseph Kennealy 38 nor ? "> aI,• sew Oor tl tot ]Ntl-?-"? / I r° ai[ ? ?'?' Fw. I•w , M V ? •e• v y ;?, . ;?•. ? :fir ) ---.''? ? 4 0 S, ?,, ?? ? 9- • o O , c.! -040 IIr ?IrMM [ 7 ?I IJac/J? th /Iww1? y 3 A+ n SS o!o A4 y d"osi! ` -- - ?. O A \ AajU ?+AS , .d. .- J P O<?\? w 00 Q CI i Ja ?Sd ? \ O 6L-oil ?M Ile??r\?2 `L?? oi' V ? u i?Iy»2 `. y ? ??oauve? Bt-o.e?»v.N y 'n1.1 g 3 toy •y /?i<d s . y Lei ? zol 4 S2101116 ?• a 7a 42 0 r _ ri Irr ?i I_S? -I NZ ' S 6S- O r . ON d>, I S uM?en sn R eol h? ? P ss-? ?o c?? S?K?rgrt.Y Si 110 - 79 100 - 79 040 - 78, 0.30 78 020 - 78 MARY ICEMMeALY t•? c G; j t, 6 ., c, Y Q ? r, c, Y ? fi RECORD OF SPECIAL ASSESSMENTS CITY OF EAGAN P A 1 0 1 N F U L L DATE RECEIPT NO. CONTROL NUMBER 1.587 CITY COPY PROJECT NUMBER TOTAL PRINCIPAL ANNUAL PRINCIPAL TOTAL INTEREST PAYMENT REDUCTION EXTR INTEREST 9T YEAR YEAR PAYMENT I PAYMENT 2 PAYMENT 3 PAYMENT A PAYMENT 5 o?? 106 Ff?l. 43 y3/ ya a9 ? A 2 /6/??`/ yr 97G 93S!rc ?% ?7 ' 5 /9?e , /, 8 /9 PCNO,wh - Deor'?g 8s a9 765°O ??71 G80.y' 638.3 l5yrs /9ya 59s?r? SS3 5i/.a? y?897 PURPOSE FOR WHICH SPECI L A33 ESSMENT IS LEVIED 111 NAME AND ADDRESS DATE DUE NO. OF YEARS ASSESSMENT DATE PARR.`( KBAlI(E4(,y (2) (3) (4) AD FR NTgG P R T N (,2r y- wura'eRrArr, *7S 2p ts) PAP 0- &L "61 - 6 -7 LOT NO. BLOCK NO. P RCEL NO. PROJECT NO. - 0 01 00-020 8 PLEASE PAY ABOVE AMOUNT Date: City of Eapil 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink For Office Use %/ , Permit #: // l' L 7 Permit Fee: (69� Date Received: -3(71 3 Staff: A777 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 'r r Site Address: 2 12 (A) 1 �_ 14-t 'h ! / �CUnit #: Resident/ Owner Name: Phone: ) 'ce 8705 - Address / City / Zip: L(ZS /ZZ. Type of Work Contractor Applicant is: Owner X 1 Contractor Description of work: Perr % Re St (fuJSe. Construction Cost: 4 ,T ii Multi -Family Building: (Yes / No) ) Company: 71-k Mil'/'lr 'v 3rvi '1' 24te, Contact: ba -1,5/4-5 &5reik Address: Zgt(( 76i-cLPI /tJE City: 6(4,41.4_ �''( State: MN Zip: Ci 41 Phone: r70 4363— Contractor 363 If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes No If yes, date and address of master plan: Licensed Plumber: Mechanical Contractor: f\) Sewer & Water Contractor: Phone: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One 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.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 DoiJck l.C7' 'GIe_ Applicants Printed Name g�i� 13 Applicant's Signature Page 1 of 3