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4558 Villa Dr RESIDENTIAL MECHANICAL Permit Application City Of Eagan q g 3830 Pilot Knob Road, Eagan Mn 55122 ~ Telephone # 651-675-5675 Please complete for: Single Family Dwellings & Townhomes and Condos when pemtits are required for each unit L Date-,~/2~-/0 3 Site Address - 1/ `4 L Unit Property Owner Telephone # 0Y;~` ) KSf 96 Contractor e //Z z-- Street Address C<<S State Zip ~6 Telephone #(7~3) Bond Espires: The Applicant is _ Owner ,---~-Contractor _ Other Add-on, modification or aiteration to exlsting dwelling unit $ 30.00 furnace replacement air exchanger air conditioner _ New _ Replacement other State Surcharge $ .50 Total J!CT 2 12001 By I hereby apply for a Residenrial Mechanical Permit and aclmowledge that the informarion is comp ete 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 [his is not a pemvt, but only an applicaHon 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 ork which requires a review and approval of plans. tw,l h Applicant's rinted Name ApplicanYs Si ature I COMMERCIAL MECHANICAL Permit Application City Of Eagan 3830 Pilot Knoh Road, Eagan Mn 55122 Telephone # 651-675-5675 Please complete for: commercial/indusMal buildings multi-family buildings when separate permi[s are not required for each dwelling unit Date / / Site Street Address IInit # Tenant Name (if applicable) Previous Tenant Name Property Owner Telephone # ( ) Con[ractor 9treet Adtlress City State Zip Telephone # ( ) Bond Expires: The Applicant is ~ Owner Contractor Offier Work Type _ New construction _Install _Remove Underground Tank _ IntefiOf ImpfoVement Schedule inspection during installation or removal of fank Processed Piping Nature ofWork: Permit Fee S50s0 ' um Fee (indudes scare surcharge) Contract Value x 1% Permit Fee • If permit fee is $1,000 or less, add $.50 ~ $ State Surcharge If pernut fee is over $1,000, add $.50 per $1,000 Permit Fee $ Total Fee I hereby apply for a Commercial Mechanical Pernut and aclaiowledge 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 Mechamcal Codes; that I understand Uris is not a permit, but only an applicauon for a permit, and work is not to start without a pemut that the work will be in accordance with the approved plan in the case of work wlnch requires a review and approval of plans. ApplicanYs Printed Name Applicant's Signature Approved By: , Inspector Date: RESIDENTIAL MECHANICAL Permit Application City Of Eagan ~ 3830 Pilat Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 Please complete for: Single Family Dwellings & Tovmhomes and Condos when permits aze required for each unit Date ~ / of- / U~ Site Address 4<-~dp A0 Unit # Property Owner Telephone # ( %3~ ) ~~~~~lJO Contractor ~~p rr~•~~TICA~"' r..r~~~.v.T.. ~I 6~~ - 8.Cii0 YYe{~l'rvcr,)r,, JJ. Street Address #e;...,,,.,.,ory (.,!y :.~1?Q City State 0814W~ ip Telephone # ( ) Bond Eapires: The Applicant is _ Owner ~ Contractor _ Other Add-on, modificatiou or alteration to effisring dwelting unit $ 30.00 furnace replacement air exchanger air conditioner _ New _ Replacement other - State Surcharge $ 50 11~~IC ';IU~I SCp n g iu93 Total / I hereby apply for a Residential Mechanical Permi[ and aclmowledge 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 star[ without a permit that the work will be in acwrdance with the approved plan in the case of work which requires a review and approval of plans. ~ r ^It r ~ ApplicanYs Printe~ ame ~ Applicant's Signature COMMERCIAL MECHr1NICAL Permit AppGcation City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 Please complete for: commerciaVindushial buildings multi-family huildings when separaze pernvts aze not required for each dwelling unit Date / ( Site Street Address Unit # Tenant Name (if applicable) Previous Tenan[ Name Property Owner Telephone # ( ) Contractor Street Address City State Zip Telephone # ( ) Bond Eapires: The Applicant is _ Owner _ Contractor ` Other Work Type _ Newconstruction _Install _Remove Underground Tank Interior Improvement Schedule inspection during installation or removal of tank Processed Piping Nature of Work: P¢I'd1lY F¢E $50.50 Minimum Fee (includes State Surcltarge) Contract Value $ x 1% Peimit Fee • If permit fee is $1,000 or less, add $.50 $ State Surcharge If permit fee is over $1,000, add $.50 per $ 1,000 Peimit Fee Total Fee I hereby apply for a Commercial Mectianical 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 pernut, but only an applicarion 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 wlrich requires a review and approval of plans. Applicant's Printed Name AppGcanPs Signature Approved By: , Inspector Date: PLUMBING (RESIDENTIAL) Permit Application City Of Eagan 0 3830 Pilot Knob Road, Eagan Mn 55122 C) ~ Telephone 4 651-675-5675 FAX # 651-675-5694 Please complete for: Single Faxnily Dwellings Townhomes and Condos when permits are required for each unit Date / 6-3 L( P1-f,- Site Address 9`.SS81 V ) IA p9r k L~Ia~! rJv~ld, /0 Unit # Property Owner ~fo,i1G C~' Son S Telephone ) Contractor pbmb,~r! Address 1?& 0 (~~/a kea- A?t . City -J-0rdavr scace M nd zip sS35~4 Telephone #~sa> The Applicant is _ "er ~ Contractor _ Other Septic System 7" New _ Refurbished Submit 2 sers of pians and MPC license $ 100.00 Includes County fee. Additional consultant fees may apply. Alterations To Existing Dwelling Unit, Including $ 50.00 _ Adding fixtures to lower leveis or room additions, excluding water softener and water heater _ Abandonment of septic system _ Water turnaround 5/8" meter if needed -$121.00) Other: _ RPZ _ new installation _ repair _ rebuild $ 30.00 _ Lawn irrigation system _ Water softener _ Water heater $ 15.00 _ replacement _ additional ~ $ .so StateSurcharge ~ AU6 1 2 2003 i LL C). 'rucai e$ 3 ~ - v C7 I hereby apply for a Residen:ial Plumbing Pernut and aclmowledge that the information is complete and accurate; that the work will be in confonnance with the ordinances and codes of the Ciry of Eagan and with the Plumbing Codes; that I understand tlus 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. \11j7LJa 1LC ~~v 9~r/~ ApplicanYs Printed Name Appl cant's Signature t , '~~.s(\ 'P' tt4,~ . ~ ° ~~i4FttVRA~~D~L~A~~r@ Srr'r'§~ ~3rSn F h E 'A, TO: DAVE BENNETT, UTILITY CONSTRUCTION INSPECTOR #S DALE WEGLEITNER, FIRE MARSHAL ERIC MACBETH, WATER RESOURCES COORDINATOR GREGG HOVE, CITY FORESTER JOlLN GORDER, ASSISTANT CITY ENGINEER KENT THERKELSEN, CHIEF OF POLICE MARK r1L`tDERSON, ELECTRICAL INSPECTOR MIKE RIDLEY, SE1vIOR PLANNER PAUL HEUER, SYSTEMS APIALYST SCOTT PETERSON, BUII.DING INSPECTOR TOM COLBERT, DII2ECTOR OF PUBLIC WORKS TONI PEPPER, CHIEF FINANCIAL OFFICER FROM: CRAIG NOVACZYI{, SEIYIOR INSPECTOR DATE: SEPTEMBER 10, 2003 RE: PLAN REVIEW FOR EAGAN CEDAR FAMILY HOUSING (CDA) LOT 1 BLOCK 1 CEDAR VII.LAS 2172 CED?.R LANE 2180 CEDAR LANE 4551 VII.LA PKWY 2175 CED.aR LANE 4552 VILLA DRIVE. _ 2176 CEDAR PASS (-4558 VII.LA D t__---- The plans are in our plan review section for your review and comment. Please return this form to mv attention with your signed comments and the date of review within seven days. If you have any concems with these plans, please so indicate on this form and notify and resolve these issues with the affected parties. If you aze requesting that issuance of the building permit be held, please fill out the proper "hold" request form. Comments• Indicate any fees that are to be collected with the building permit: AMOUNT ? Yes ? No landscape security required Z O N I N G? ? Yes ? No water quality dedication METER SIZE ? Yes ? No park dedication ? Yes ? No trail dedication ? Yes ? No tree dedication ? Yes ? No PRV Required Signature Date ' PLUMBING (RESIDENTIAL) Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 (z2 I Q~C) Telephone # 651-675-5675 FAX # 651-675-5694 Please complete for: Single Family Dwellings Townhomes and Condos when permits are required for each unit Date`,z-a-/-4Z/-L)-i Site Address Unit # Property Owner Telephooe # ( ) r Contractor Address If lVfla 0P CT cicy State Zip 3~3 Telephone #7j~? ) v- IOE~~d The Applicant is _ Owner X Contractor _ Other Septic System New _ Refurbished Submit 2 sets of plans and MPC license $ 100.00 Includes County fee. Additional consultant fees may apply. Alterations To Existing Dwelling Unit, Including $ 50.00 _ Adding fixtures to lower levels or room additions, excluding water softener and water heater _ Abandonmenl of septic system _ Water turnaround 5/8" meter if needed -$121.00) Other. _ RPZ _ new installation _ repair _ rebuild $ 30.00 _ Lawn irrigation system _ Water softener _ Water heater $ 15.00 _ replacement _ additional o ~ $ 50 State Surcharge nrT t% $ 3~0 Total iRy I hereby apply for a Residential Plumbing Permit and acknowledge that the i is comp ete and accurate; that the work will be in conformance wi[h the ordinances and codes of the City of Eagan and with the Plumbing Codes; that 1 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 approve -plan in the case of work which requires a review and approval of plan_---5. < Applicant's Pr ted Na e Applicant's Sig ture La ~ a- 6\ n ck- \ (o [ 2~ CsQ.d-o- y- v -1 ~ lo-S con+uMERCZar. 2002 BUILDING PERBaIT APPLICATION CITY OF EAGAN O S-f. 43 ~ Ci - J r~ I 651-681-4675 Foundation Only New Construction Interior Im rovement . SVUdurel Plans (2) cets . ArchilecWral Plans (2) uts . fvchitecWral Plans (2) se4s . Civil Plans (2) . StrucWml Plans (2) . Code Analysis (1) . CerfificateotSurvey (1) . CNilPlans (2) . Pro1ect SPecs (1) • Code Anarysis (1) " . landscaqng Plans (2) . Key Plan (1) . Pro)edSpecs (t) . CodeMalysls (1) ^ . MasterExitPlan (1) . • Spec. IMp. & Testing Schedule ° . Certificate of Survey (1) • Energy Calwlations (1) not ahvays" • Shca Report (1) . Spec. Insp. $ Tesdng Schedule (1) " • Elec. Power & Lighdng Form (1) not always" • Meler size must be established • Meter size must be established • Meter sae must be established - if applicable . Projec3 Specs (1) 1 . EneryryCalculations (1) " y . 1 • Electric Power & ughtiig Form (1) 1 . Masfer 6dt Plan (1) 1 1 • Emetgency Response Slte Plan (7) 1 • SoIlsReport (1) 1 . MGES SAC determinadon letter . MClES SAC detertninatlon Ietter • MC/ES SAC detemiination letter ca11651-M-1000 call 651E02-1000 ca11651-802-1000 Food 8 beverage or bdging facilities - submft plan to MN Department of HeaHh. Call 857-215-0700 for details. " Corrtad 8uilding Inspections for sampte. "•PermitfornewbuildingsoraddittonswillrrotbeprocessedwflhoutE encyResporueSitePlan.AskB *ldinglnspectionsforrequirements. DATE: /l/U '02 WORK E: X NEW _ REMODEL CONSTRUCTION COST:~~~iO~D e~ , S ; 1 l a SITEADDRESS: TENANTNAME: Cedar Villas Housing SUITE#: ~ FORMER TENANT NAME, IF APPLICABLE: DESCRlPTION OF WORK C:rtx't1rvL Name: Cedar Villas, LLP. Phone#: 6( 12 ) 341-7800 _ PROPERTI' Last First OWNER SheetAddress: 900 GPCOnd Avenue South, Suite 880 Cit,. Minneapoli.s gmte; MN Zlp; 55402 Companr Frana and Sons, Inc. ' Phone#: 9,2 r43)9,-Qo-' I II~~c' CONTRAGTOR ` 633 Second Avenue Sou'th I~ NJV 21 Kr~'72 l~~l Sueet Address: L City: Hopkins Sffite: MN Zip: 55343 ,4ItCHITEGT/ ENGINEER Company: Elness Swenson Graham ArchitectsPhone#: ( 612 ) 339-5508 Nnme: David Graham Registration#: 14808 SucetAddress: 700 Third Street South ~ity. Minneapolis 5tate: MN Z;p: 55415 UcensedplumberinstallingnewseweHwaterserviee: Imperial Developers phone#: 6( 51 ) 454-3330 t hereby ackrqwledge that I have read tlUs applicaWn, state that the informatlon is corred, ag ~omp wi appflcable State of Minnesota Statutes and City of Eagan OMinances. l/~ Signature of Applicant Updated 7/02 OFFICE USE ONLY SUBTYPE ? Ol Foundation ? 26 Public Facility ? 30 Accessory Bldg. ? 14 Apartments ? 27 CommerciaUlndustrial ? 32 Ext Alt - Apts. ? 15 Lodging ? Zg Greenhause ? 34 Ext Alt - Comm ? 25 Miscellaneous ? 29 Anteimae ? 35 Ext Alt - PF O 37 Nail Salon WORK TYPE ? 31 New O 35 Tenant Impr ? 42 Demolish (Foundation) ? 46 Windows/Doors O 32 Addition ? 36 Move Bldg ? 43 Reroof 0 47 Repair , ? 33 Alterations O 37 Demolish (Bldg) ? 44 Siding ? 48 Authoriza6on 0 34 Replacement ? 38 Demolish (Int) O 45 Fire Repair GENERAL INFORMATION Census Code Zoning sq.ft. SAC Code # of Stories sq. No. of Units ~ fL No. ofBldgs• Width sq..ft.. Const (Adual) Basement sq. ft. MCBS Systein (Allowable) First Floor sq. ft. Ciiy Waber UBC OocupanoY sq. ft. Fire Sprinklened MISCELLANEOUS INSPEG7`IONS ? Gas Service Test ? Heating ? Insulavon 4 Plumbing ? Stucco/Stone APPROVALS PbnninB Building Engineering Variance Pertnit Fee aS 3 93 S VALUATION $ 7 6, "-b surcharge / ~f ~ • ~ ' . '!an Review ~c S'G • S~ VIC/ES SAC Ln • % SAC -ity SAC . - " SAC Units Nater Supply & Storage 3~ a o. 6U Meter Size i/W Permit i/W Surcharge . 5 L) : reatment Plant 'ark Dedication 'rails DedicaGon - Vater Quality )ther :opies ! 'otal I 6 , a S~• S3 COMMERCIAL BUII,DING Permit Application , City Of Eagan ~ 3830 Pilot Knob Road, Eagan Mn 55122 U ~ Telephone # 651-675-5675 FAX # 651-675-5694 S- 4 ~3 -6 71 cj Foundation Onl New Buildin Interior Im rovement • Structural Plans (2) sets . Architectural Plans (2) sets . Architedurel Plans (2) sets • Civil Plans (2) . Structural Plans (2) • Code Analysis (1) • Certificate of Survey (1) . Civil Plans • CodeAnalysis (1) " . Landsca in Plans (2) . ProjectSpecs P 9 (2) • KeyPlan (1) . ProjectSpecs - (1) • CodeAnalysis (1)• Master Exit Plan (1) Spec. Insp. 8 Testing Schedule " . Certifiqte of Survey (1) . Energy Calculations (1) not always" - • Soils Report (1) • Spec. Insp. 8 Testing Schedule (1) . Elec. Power & Lighting Fortn (1) not always° • Meter size must be established . Meter size must be established . Meter size must be established-if applicable - y • ProjectSpecs (1) L • Energy Calculations (1) . Electric Power & Lfghting Form (1) . 1 , • Master Exit Plan (1) y L • Emergency Response Site Plan ,(1) l • Soils Repart (1) y • SAC determination - call 651-602-1000 . SAC determination -call 651-602-1000 SAC determination -call 651-602-1000 Call MN Dept of Health at 651-215-0700 for details regarding tood & beverage or lodging facilities. . " Contact Building Inspections for sample and if required when it states "not always". Permit for new building or addition will not be processed without Emergency Response Site Plan. Date _g_ Z_y-_ iS S B V j I Ia Dr Construction Cost ~ SiteAddress Er ±11 A - a Bldg Tenant Name Eaaan Cedar Former Tenant Name Descripflon of Work ( 34 )Townhomes and (1) office in 7 buildings PropertyOwner DakoLa County CDA Telephone#( 651) 675-4400 Contractor Frana and Sons, Inc. , Address City Honki na State Minnesota Zdp~ L. qi,l~ Telephone#(g52 ) 935-8600 110 I t '1 Arch/Engr J~ Registrarion# 17402 Address 25 hird- venu City Minneapolis State Minnesota "75p 55401~ Telephone # (612 ) 338-2029 Licensed plumber installing new sewerlwater service: Phone I hereby apply for a Commercial 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 ofplans. Gtbxask Rgstul AJ-di ApplicanYs Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 26 Public Facility ? 30 Accessory Bldg. 14 Aparhnents ? 27 CommerciaUIndustrial ? 32 Ext Alt - Apts. ? 15 Lodging ? 28 Greenhouse ? 34 Ext Alt - Comm. ? 25 Miscellaneous ? 29 Antennae El 35 Ext Alt - PF ? 37 Nail Salon Work Types )e 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/DOOrs ? 34 Replacem0nt •Demolition (Entire Bldg only) - Give PCA handout to applicant d4+ ? Valuatian ~o &W ) r Occupancy R• Z- MC/ES System Census Code ~OS Zoning City Water SAC Units S Stories 2 Booster Pump. Nbr. of Units ~ Sq. Ft. 47~ PRV Nbr. of Bldgs ~ Length Fire Sprinklered ~ Type of Const V13. Width REQUIRED INSPECTIONS " Footings (new hldg) FinaUC.O. _ Footings (deck) Fina]/.Vo C.O. Footings (addikon) Plumhing ? Foundaaon HVAC ? Drain Tile / Other Roof ?Ice & Water ? Final Pool Ftgs Air/Gas Tests _ Final ? Framing _ Siding Stucco Stone Fireplace _ R.I. _ Air Test Final Windows (new/replacement) I/ Insulation _ RetaiaingWall DUPL/ Approved By Building Inspector a " Base Fee 3 r77 . 7 5' wA- r-r--A` A't C-r E"W, ~ Surcharge 24c- . o 0 5+88. Z~ Plan Review Z06 S- 5-9- MC/ES SAC 0 37`S • &-v (BLO4, AL el- 1 City SAC 0 e • ~ ~ Water Supply & Storage S/W Permit 1 O C~ O u SNV Surcharge `_~D Treatment Plant y~7-0 • o-" Park Dedication Trails Dedication Water Quality Copies Other i " 'M,e-k.e 0 0 Total , K~..,,,_-' j - ~ Q.,1111. TO: DAVE BENNETT, LITII,ITY CONSTRUCTION INSPECTOR ttS DALE WEGLEITNER, FIRE MARSHAI. ERIC MACBETH, WATER RESOURCES COORDINATOR GREGG HOVE, CITY FORESTER JOHN GORDER, ASSISTANT CITY ENGINEER KENT THERKELSEN, CHIEF OF POLICE MARK ANDERSON, ELECTRICAL INSPECTOR MIKE RIDLEY, SENIOR PLANNER PAUL FIEUER, SYSTEMS ANALYST SCOTT PETERSON, BUILDINTG INSPECTOR TOM COLBERT, DIRECTOR OF PIIBLIC WORKS TOM PEPPER, CHIEF FINANCIAL OFFICER FROM: CRAIG NOVACZYK, SENIOR INSPECTOR DATE: SEPTEMBER 10, 2003 RE: PLAN REVIEW FOR EAGAN CEDAR FAMILY HOUSING (CDA) LOT 1 BLOCK 1 CEDAR VILLAS 2172 CEDAR LANE 2180 CEDAR LANE 4551 VILLA PKWY 2175 CEDAR LANE 4552 VILLA DRIVE 2176 CEDAR PASS 4558VII.LADRIVE The plans are in our plan review section for your review and comment. Please return this form to mv attention with your signed comments and the date of review within seven days. If you have any concems with these plans, please so indicate on this form and notify and resolve these issues with the affected parties. If you aze requesting that issuance of the building permit be held, please fill out the proper "hold" request form. Comments: Indicate any fees that are to be collected with the building permit: AMOUNT ? Yes ? No landscape security required Z O N I N G? ? Yes ? No water quality dedication METER SIZE ? Yes ? No park dedication ? Yes ? No trail dedication ? Yes ? No tree dedication ? Yes ? No PRV Required 5ignature Date Use BLUE or BLACK Ink r For Office Use Permit 50 nn Q 1 City of Ea a~ I Permit Fee: 5 0 4• o`s 3830 Pilot Knob Road Q Eagan MN 55122 1 Phone: (651) 675-5675 i Date Received: Fax: (651) 675-5694 j Staff: j t-----------------I 2013 COMMERCIAL BUILDING PERMIT APPLICATION Date: q/jqjj3 Site Address: 1 0 114 or Tenant Name: 6Cdar 11111a $ (Tenant is: New / Existing) Suite Former Tenant: L 9 spry Name: ~.~~'PL'~!D`/C)a1 ~ Phone: Property Owner Address / City / Zip: U®0 ~ 1'101 Gr0 5.f roV, c Applicant is: Owner ' Contractor Description of work: T d ~ T ~ i ~ 1 h Type of Work Construction Cost: 1 Name: (,4-gf-Aen License i Contractor Address: o:w g /01 AY, ! l (p City: 6-y Id e,, State: n Zip: Phone: '763- - l 3 0 0 Contact: V'`li /'b4/2k-7 Email: UQ M I 'erl-' '-Ic® ° Name: Registration Arch itect/Engineer' Address: City: State: Zip: Phone: Contact Person: Email: Licensed plumber installing new sewer/water service: _ _ 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 the 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.org 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. x ~ ~rl1l / /0 x Applicants Printed Name Applica is Signature Page 1 of 3 To: Page 6 of 8 2014-09-26 13:33:42(GMT) 18772375198 From: Danielle Merritt Use Bk:t��+�r°�L+A�CI�9nlc � KcrOf�icatiser --` .__....g }. 1 . . j. Permit fi�:. � �1 � . � ��t� D�� ; .�� r , ne�,�t��: , ` 383�Pilat�fnob Road _ o ? ` �aganMh1:�51Z2_ � (�ate.Recaived;, i - .. Phr�ne:F6S1)fa75-5S75 i � �au:(6�9}675�569�4 ' Staft: . i _ , _ ,_._,__...�.._�....�...�.�..�..e___�' _ 2�14 i��S11��1�{�`Ii�►L �3U1L.Q1�'+1G PEI�,M1�' APl�LIC�cTi4Jt� C�at�: � ��.�56� �': Site Addres�: �� :, .,�`� �?� ��'�i. �r� ��'�" � :�"�" �- Unit#: ��° �'`� � �' � ��l�r .� - ._ ..� : .. .. -..� � . ,. ;,k,.�,,,�,• •�: Narn�: �:.._�� ` �.� ��I ��F Phone: Address!City/Zip; � �'� �� ..�.�{�tJ�� C.. �'�ft �� *.�f�. ��4� f( ��:! 7 �+�Plicant is: Qwner �Contr�ctor _ � ` � � � i�'.� Descr�ptian af work:�� .�'�` ��;,�:: �� ConSiruc%ion.C;;ost. ..�{r�, �.�� ftiAultf-E�7mity Buitding:{`feS�t No,�,,,,� Carnpany' �� d t�� J��".�� !�'�� Gontact: �' � ��,� 1 � � �°°� > �ddress: � G ��l ��.�� °�-r�E?f✓ ��' city: fC'��" �� F I�t$ ��;'� �f��,.��'��u: ��tr t�L�'i�°1'rr�'t° ��°f� � ta�, "° State; Zip.� -Ph�ne.. �..�,t� Li�ense#: ��.�}��! � � � I.�ad!Certi�CBte#: ! ?� �t � C/J`" If the praJ�ct is axempt frcam 1�ad certificat�on, please�xpi�in u��r:{ses Page.3 for ad.ctitionaf infprmat�oM) CC�MPLET�THl a.�R�A C3�1LY RF GOIVSTRUG"fi�iG A NEV�!„BUtLC?ING :1n the 1�st t2 months,has#he City cf�gan issued a perrnit far a s€mifar.p(�n taa�ed on a master pla�7 _._Y�s �NO. If y�s,date and address of m�ster plarr _ ' . . _. Li��eresed-f�lumbe[: Phone; , .. M�chanical Gontract4r: F`hone: Sew�r&W�ter..Contractor: ` ' F�hon.e.; �iA�L��FQE"��1?`�ll�DEG. C�It Gapher.�tate Qne CaEI at(851�454-t1b02 for protecbon 2gainst underground utilliy damage. Ca1f48 hour� hefare you in[and fci dig to rsceive facates of undecgrnund.utilhies. �w.qooherst�teonerall.ora t he�eby acknawledg�th�t this infarmation is complete and�ceurate;3hat the�uork tinnli be in ctinforrrs2nce with ths nrditaanc�s�nd cn�es of th�a�ity sz� Eag�n: thaf:!understand this is not a permit,but only an application for a permit, and.work is.not ta start without a permit;tha!tl�e w+nrir�ii1:6�{n �ec4cd�nc�with fF�e.�pproved:pl�n in the cass of wtrric wMich requires a reuiaw�rsd approval 4f plans. �:x4.erinr work authoriz�d by�aUitdrng_permit issued in accordance writh£he Minnesata State E3uildizua Cade must h�comp(eted?�pthir�180 . F�.;.- .. . daya oP permit issuarrce, a � x �.l�,�1 �,,,,,,�� :�t ��,�_ � � A,p�rfi�ant's Printed�lame ApPli�ant's Signature Pag�3't rsf s