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1716 Walnut Cir4101111P _ C!ty oI Eaan 3830 Pilot Knob Road Cag e, SAM A'?? Phone: (651) 675-5675 Fax: (651) 675-5694 1 Use BLUE or BLACK Ink rrstiza fr Permit Fee: ' 6 LlaLC f[CtiGIYCi]. 1 Staff: L 2010 MECHANICAL PERMIT APPLICATION ii Date: to i S)) 0 Site Address: 1-7/ L W o)17,A- Cy'e at -- Tenant: Suite #: RESIDENT /OWNER CONTRACTOR Name: L1-)4' _ Address f City f Zip: __I '7I b Phone:(, t t -)P(S)3 Naive: k . Lg . J v u4�z__ License t#: 0 0 ' - ))--L..? Address: 1130 C- W �+?4i A4 1) City: to - State: /l7k77 Zip: S I / --7 Phone: 4Firiaiiiiieet - 911 %ids Contact "gr' icy.,, Email: TYPE OF WORK New Replacement Additional Alteration Demolition Description of work: PERMIT TYPE RESIDENTIAL coFurnace Air Conditioner _ Air Exchanger Heat Pump Other ERCIAL New Construction Interior Improvement install Piping _ Processed Gas , Exterior HVAC Unit Under / Above ground Tank (-_ Install / _ Remove) When installing/removing tank(s), cat; for inspection by Fire rshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ TOTAL FEE COMMERCIAL FEES: $70.50 underground tank instaattationfremovai OR Contract Value $ x 1% $50.50 Minimum (includes State Surcharge) $ Permit Fee - If Permit Fee is less than 31,000, surcharge s $.50. - If Permit Fee is > 31,000, surcharge increases by $.50 for each = $ Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). $ TOTAL FEE CALL BEFORE YOU DIG. Call Gopher State One Calf 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.00pherstateonecaliorn I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the Cty of Eagan; that I understand this is not a permt, 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 "7cw ) 1 e -' S n Applicant's Printed Name x Applicant's Signature FOR OFFICE DSE Required insp+ _ City al hap 3830 Pilot Knob Road E :2„ uMN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 MAY 2 V REC1 r Use BLUE or BLACK Ink Forr �FCYiilii fr. j Permit Fee: 6--D ' ``J 0 I Date Ret ivc : i/ I Staff: C I L- 2010 2010 MECHANICAL PERMIT APPLICATION Date: 5) )10- Site Address: ) / C e—v.e/ e -- Tenant: Suite #: RESIDENT / OWNER Name: is t1 h ei Address / City / Zip: Phone: Lai ---,gra CONTRACTOR Name: ,g f g . Ste' V ; Address: State: PM zip: I / '-i Contact: 'Sr" o may. License #: a 0 1 i"--421 q3 0 - ,;�,� b city: )Thr_ Phone: 44e0agaikritag& t. % ygl--��tSS Email: TYPE OF WORK New Replacement Additional Description of work:••rma c -q -- Alteration Demolition i9 tie PERMIT TYPE RESIDENTIAL V/ Furnace Air Conditioner _ Air Exchanger Heat Pump r New Constructio fnstaff Piping Gas COMMERCIAL Interior Improvement Processed Exterior HVAC Unit Under / Above ground Tank (,_ Install / _ Remove) "When installing/removing tank(s), tag for inspection by Fire Marshal and Plumbing inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) ,5b.$8 TOTAL FEE COMMERCIAL FEES: $70.50 underground tank instaiiationlremovai OR Contract Value $ x 1% $50.50 Minimum (includes State Surcharge) _ $ Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. - If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge $1,000 Permit Fee (;:e. a $1,001-$2,000 Permit Fee requires a 51.00 surcharge). =$ TOTAL FEE CALL BEFORE YOU DIG. Cali Gopher State One Cali 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.gopherstateonecaliorq 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 mark which requires a review and approval of plXans. 47,"-10#— x rea t )1LCi 5tr, Applicant's Printed Name Applicant's Signature CITY OF EAGAN 3795 Pilot Knob Rood Easan, MN 55122 N! 6336 PHONE: 454-8100 BUILDING PERMIT Receipt # To be utad far Est. Volue Date , 19 Site Mdress Ered 0 Octupancy Lot~'- I Block SeclSub. Alter ? 2oning parcel # Repair ? Fire Zone Enlorge p Type of Const. oWe Name Move ~ # Stories Z Address Demolish ? Front ft. ~ Ci phone Grode ? Depth ff. `r Nome APprovals Fees ,o Address Assessment Permit ~ Ci Phone Water & $ew. Surchorge Police Plan check ~ ~W Name Fire SAC Address Eny. Woter Conn. a~ G Pho~e Plonner Water Meter - Council Rood Unit I hereby ocknowledge that I hove read this opplication and state that gldg. Off. the informction is wrred ond agree to oomply with all applicable $tote of Minnesoto Statutes und City of Eogan ardinances. APC Totol Signcture of Permittee A Building Permit is issued to: on the express condition that all work shall be done in occordance with oll opplicable State of Minnesota Statutes ond City of Eagan Ordinances. Bullding Official . hnnM ~ pote Inaed hnniMN Plumbing Me hanicol e- / INSPECTIONS DATE INSP. Rouqh-In Final Footings Date Insp. Dote Insp. Foundotion Plumbing Frome/ins. Mechanical Final 4 S / Remurks: CITY OF EAGAM Remarks Addition Woodgate 2nd 1 Lot Blk 7 Parcel owner ` I~' street 1716 W11.t1ut Ciz'Cle state f''-~~~,~N 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF, ~5 3 5.11 1.02 s Paid STREETRESTOR. ~97 1 0 •75 3 •92 3 Pgld GRADING SAN SEW TRUNK 1 99 . 2 6.63 1 PaiCl -ASEWER LATERAL /3 197 3 .71022.90 3 pa3.d WATERMAIN *UATER LATERAL 97 3 3dNATER AREA 197 3 ifSTORM SEW TRK 197 3 -3S6TORM SEW LAT 197 3 CURB & GUTTER SIOEWALK STREET LIGHT WATER CONN. 140.00 12453 12-20-74 BUILDING PER. sAC 00.0 12453 - - PARK INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: APPLICANT: ~ i, Ir„t W, i ~ I tr ~ 1lInIqA`, PERMIT SUBTYPE: TYPE OF WORK: INSPECTION . jr~~, F ~ L Permlt No. Permit Holder Date Telephone N SNV PLUMBING HVAC ELECTRIC ELECTRIC Inspection Dete Insp. Comments Footings I Foundation Framing Roofing Rough Plbg. Rough Htg. Isul. FireplaCe Fnal Htg. Orsat Test Final Plbg. Pibg. Inspectw- Notify Wumber Const. Meter EngrJPlan Bidg. Final Deck Ftg. Dedc Finai ~1{T Well Pr. Disp. ~ - CI7 Y Or F,Ar::N 3795 i ilot Iu.ob P.oaa Minnesota 55122 . PF:RPaT NO.: The City of Ea.gan hereby g.rants to E23 nf f:An. :'r3c'rn,7iCk :'E'BtiIIq & A/C Co. Permit for: (Owner) ~ . •~~i;l .'.ve. pursuant to application dated _ fh;*•.TING Ne~?~Horizon - Woocigate II F.e ~.~t11~03-G= . "7 •iicla~acye~i~i, 17] lb~~ = .,Q.? 'L700-02-0.41M Hickory Hill 12/13/ and 12/6/74 , . t $180.00 31 Dec. 74 4.50 s/c Huildin8 Inspector• ,i,n ..:9...:~,.... kl.?`~~;t• ~ ~i-:ec?:anical Per^:its: 3i•1 ^o twl : ; CITY OF EAGAN ~ 3795 Pilof Knob Read Eagon. MN SS122 N? ~ fi336 ° ' ' PHONE: 454-8100 G BUILDING PERMIT APPLICATION Receipt # Te be uaed for ROOM ADDITION Est.Volue 7~000 Date 11-3 ~980 S~te Address ~7~6 WaLnut Cir. Erect xg Occupancy R3 Lot 1Q_ Block 7 Sec/Sub. WoOd~8t2 2rid Alter ? Zoning PD Parcei # Repair ? Fire Zone 3 Enlarge ? Type of Const. V rc Nome ~thoriY Stai'CeVie . Move ? # Stories ~ Address San12 flS 8bOV2 _ Demolish ? Front 13'6 ft, ~ Ci Phone ~+52-600/. Grade ? Devth 14'0 h. o Name Gerald Christian AvP~orals Fees Address Rt. 2 Assessment Permit 24.00 ~ C~ L~keville, ~ Phone ~61-3293 `Nater &$ew. Surchorge 3.50 . Police Plan check 12.~~ ~w Nome Fire SAC ~ Address Eng. Water Conn. u aW G Phorre Plonner WuterMeter Councll Rood Unit I hereby acknowledge thot I have read this apDlicotion a~d state that g~dg. Off. the informotion Is correct and ogree to comply with alI applicable 9.50 Stote af Minnesota Statutes and City of Eagan Ordirwnces. APC Total Signoture of Permittee . A Building Permit is issued ta (*Pral d Chrlstian on the express condition thot oll work sholl be done in accordan/ce,f/[~~+ith ~nl~l ap0~~iwble Stote of Minnew Statutes and City of Eapon Ordinances. Bui~ding OfHcial wT^"~-~`~-'~ r, CITSt OF EAGAN Include 2 sets of plans.. 1 site plan w/elevations & BUILDING PE1~7IT APPLICATI ~ set of energy calculations. ~ Be Used For?on~ 2tDiTi , Valuation Ago Date / o- a S- P-0 Site Pddress 17/4, 64)a• ur (21,edA6 ~i~6f1.v OFFICE USE ONLY Int 0 0 slorak f) -7_ sec./sub. l,1,,,,,~~~,~ Frect occupancX i~. ~ Alter Zoning ~ Parcel RPpair Fire Zone O'mer: Ay? H-o,u y ~i R e Enlar4e _'IYPe of Const. I JA-L-,vu L~ z? C(-E Move # Stories Address: Lc Demelish Front ft. City/Zip Code: Grade Depth ft. Phone # : -%•5 -m2 0 0 k/ I APPROVPSS F'EES ~ Contractor:C-7;,c aA L- C> oN,eiSTiA-J Assessments Pexmi.t y ~ ?aater/Seaer Surchan3e Pddress: ,.(A es-u i 6c E Police Plan Check City/Zip Code: Z/~/ Fire SAC Phone 3 Eng. Water Conn. Planner Water Meter ~g• Council Road Unit Bldg. Off. Address: APC City/zip Code• Phone # : TOrAL or HOUSE HEATING TEST RECORD D-2~5~9 ? ADDRESS 1716 Walnut CiTCle APT.-FLOOR CITY SUBURB ESaan OCCUPANT none OWNER New HOrizODe HEAT LOSS DATE HTG. INST. SOLD 8Y INSTALLED BY Sedgwick HeatiIIg Elechical Work By Gas Line By is 17 TYPE OF HEAT GA FA gHW STEAM -SPACE HTR. -UNIT HTR. -OTHER % GAS DESIGN CONVERSION MAKE WillinmRnn MAKE OF BURNER Modal 1717-07 5 Model Smia1 7441897 " Ma:. BTU Rating INPUT 75~.Qh0~/hr MAKE OF FURNACE Model CONTROLS THERMOSTAT n10260 Heat Plug Vent Size 411 yalve M,$ VRfI(1C KIND OF LINER alnm SIZE fi" NONE Limit 11.+hvham R.F'I 750 DrofrHood YP.rtd PA1 Regularor Limit SeMing 9,00f . Filtsrs Size ].sRPr+ Number 1 Fan Senin9 U()f 12nf Chimney Locufion Inside y>9 Outsids PilotType r.nnpl ChimneyConstruction metal hyatnA Pilot Make Pilot Model Smoke Bomb Wiring Pilof Timing 59, Aan._ Draft Oti Test Tag TA L.W. Cut Off Door Pressure Lighting Inst. T?8 Prossuro 4,q°u+r. PercentCO2 7,0% Date Teated 2/1aL75 Input CFH 74 Percent 02 A 7~% Company Testing $taek Temp. 52~ Percent CO Q•0"N Name of Tester Form 235 ~ ~ CITY of EAGAN N°- 3503 BUILDING PERMIT Own~: 3795 Piloi Knob Road . ~ agan, Minnesota 55122 Addraa (Preseni) .._~.°2:~'~ - 454•B100 Suilder aatt Addreu DESCAIPTION 5toriso To Be Used For Froa! Dsplh Hsigb! Enf. Cos! Permi! F~a ~ Aemesks LOCATION a~{7 ao Slreal, Road or ofher Descrlpiioa ai Localion Lo! Block Additioa or Trac! / 7/c,. ~ /7/~ ~i •i This permif does nof auihorise the use ot slreele, roeds, alleyc or sidewalkc noz does it give the ownsr or hb ayenf the :ighito ereale any siluation which is a nvisanca or which prasenls a hasard !o the healih, sefety, convaaisnce and ganeral weliare to anpone in the eommunifp. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. _~~'^.^..c'_ This ia 2o certify, ida! has permisnion !o ereet ` _...........--_upoe the above described premise subjeof to ifie provisions of all applicable Ordinances for the Ci1p of Eagan. ~ Per ....---_...._l.SX^-..`.:S'-'....?7................................. ` Mayor ~j Buildinq Impxlor ,Ci vil.Uae ov EncaN WATER SERVICE PERMIT 3795 Piloe Knob Rood PERMIT NO.: 1667 DATE: 12/20/74 Eagon,MN 551I7 Zaning. p~~n No. of Units: Owner: x~ i F•-~--•- ~•~nnAnata / Address: Site Address: 4-7-,15--WalAUt--CirC].e ~ Plumber: mhom 1A0.00 pd Meter No.: Connection Charge: Size: Account Deposit Read o.: ~ ~ ~ Permit Fee: -1(1..42i~• 1 agree to co Dly wifh tha Villoge oi Eagan Sutchazge: v Ordinonca~ Misc. Charges: 4I f . To[al: By ~ Date Paid: I Da e of Insp.: Insp.: YIlLA6E OF EA011N SEWER SERVICE PERMIT 3795 Pilot Kmb 0.oad PERMIT NO-: 2427 ~ ~ ~ 2 ~ 4 Eaqan, MN 35121 DATE: Zoning; PTIT) No. of Unlcs: I Owner: Addresa: Site Address: o. Plumber: 400.00 paid I ugrea to wmply with eM Villags ef Eagan Connection Chazge: OrdinaMas. Account Deposlt: Perrrtit Fee: 10•00 P-4- . 50 Surchazge: Misc. Charges: By: Date of Insp.: TOtal' Insp.: Date Paid: PERMIT ~ CITY OF EAGAN 171" 3830 Pilot Knob Road PERMIT TYPE: g uILo x N Eagan, Minnesota 55123 Permit Number: 0 2 3 4 3 4 (612) 681-4675 Date Issued: 0 4/ 2 7/ 9 4 SITE ADDRESS: 1716 WALNUT CIR LOT: 1 BLOCK: 7 WOODGATE 2N0 P.I.N.: 10-84601-010-97 DESCRIPTION: BuildingtPermit Type DECK Building Wbrk Type NEW ~ ti zl 1 `i 1 ; REMARKS: FEE SUMMARY: 8ase Fee $30.00 Surcharge $.50 7ote1 Fee $30.50 CONTRACTOR: OWNER: - Applicant - LENTZ THOMAS 1716 WALNUT CIR EAGAN MN 55122 (612)688-7883 S hereby ackn-ouledge that I have read this application and state that the in'formation is carrect and agree ta comply with all applS:nable 5tate pf Mn. StaCutes and City ofi Eagan Ordirtances. L J ~ ~ I-- APPLICA EflMI SIGNATl1RE ISSUED B SIG ATUR INSPECTION RECORD CITYOFEAGAN PERMITTYPE: suzLaiNc 3830 Pilot Knob ROad Permit Number: 0 2 3 4 3 4 Eagan, Minnesota 55123 Date Issued: 0 4 J 2 7/ 9 4 (612) 681-4675 SITEADDRESS: LoT: 1 BLOCK: 7 APPLICANT: 1716 WAl.NUT CIR LENTZ TWOMAS WOODGATE 2ND (612) 688-7883 PERMIT SUBTYPE: TYPE OF WORK: DECK NEW INSPECTION . .A FOOTINGS FINAL F ~ L 994 BUILDING PERMIT APPLICATION 13434 6 81-4675 L4 ,4 &I r wK-; 335-AC3 e 0 1.rf 4- 1~ U-"~ 5IN6LE & MUITI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy Cd1C5. - i' 1 COMMERCIAL 2 sets of architectural & structural plans,._1_ set_of specifications, 1 copy of energy calcs. y Penalty applies: i) when permit is typed, but not picked up by last working day of month in which request is made, 2) address is changed or 3) lot change is requested ance permit is issued. Date / 22 / Valuation of work 5ite Address: L2ada-r- ['c"UG STREET SVITE # Tenant Name: (commercial only) LOT BLOCK ~ SUBD. 1L,)&006A7E SF_[onll~ P.I.D. # A iJpL n Descri tion of work: The applicant is: Owner ? Contractor ? Other (Describe) Name LF,nfl'i ~//~6IZ45 Phone y/"7g-?3 Property Lasr FIRST Owner Address /z/(o Z~~~,T ~y STREET STE q City '~~A State "~O// Zip Company Phone Co ntractor Address License # Exp. City State Zip Company Phone Architect/ Engineer Name Registration # Address City State Zip Sewer & water licensed plumber Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: 1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN 3830 PILOT 651 ~ ~ g q q - 8/46 5. S5'12Z New Consiniclion Reauiremeh Remodel/RecaU ReauUements D 3 regisfered sHe suneys showtng sq. tt. of lof, sq. M. of house 2 copies of plan and QII roofed areas (207, maximum lof covmaae allowed) 7 set of energy calculatlons for heafed addlHOna m 4 coples of plans (sM1ow beam 3 window s@es; poured fnd. design; efc.) 1 aRe suney for exferior addHbns a decks ? 1 set of energy calculations D 3 eopies of hee preservafion plan H lot plalled a1Mr 7/1/93 DATE: CONSTRUCTION COST: C70 DESCRIPTION OF WORK: STREET ADDRESS: 1 a~ LOT: ~ BLOCK: ~ SUBD./P.I.D. Name: Phone (~z46 0 - ! 4 0 ? PROPERTY T Lcst ~ Ftrst OWNER f~ / d~~J/ 1 ` Street Address: L//J /3'~ [ Ci1y Z4, WI^~ State: Zip: Company: aL - r W Phone (4Jl (area code) CONTRACTOR Sheet Address: License # ow ! Exp. 3JI D City State: Zip: ARCHITECT/ ENGINEER Company: Name: Telephone area code ( ) Street Address: Registration Cffy State: Zip: Sewer & water Ilcensed plumber (reaulred for new consiructton onlv): Penalfy applies when address ehange and lot chonge is requested once permR is issued. 1 hereby acknowledge tha} I have read lhis appltecNon, stale that the Intorrtoflo Is correcd g~ ply wRh all applicabl State of Minnesoia STafutes and Ctty of Eagan Ordinances. Slgnature ot Applicant: OFFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received _ Yes _ No _ Not Required I 2007 RESIDENTIAL BUILDING rERMi'r nrPLICnTioN City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 RemoddlReoair Reauirements OKce Use bnlv New ConstNC6on Reauirments 3 registered site surveys showing sq. tt. of lot, sq. R. of hause; and all raofed areas 2 copies d plan showin91oo6nqs, 6eams, loists CeA of Survey Recd~ , =Y .-y (20%mazimum lot coverage albwed) 1 set of Energy Calculatlons for heafed addihons $a15;~2epat Te2„Ptes PWO ReW.'; Y' : disNr6ed soil 1 , site , surv?Y for additions 8 decks " 1 Soils Report if proposed building is to 6e placed on N 2 cop'~es M plan showmg beam 8 windmv sizes; poured found design, ete. AddNon - Mcficafe M on-sife septic system 0, site Septl~c System Y~N 1 set of Energy Calwlatlons 3 copies of Tree Preservation PWn'rf lot platled after 711193 Rim Joist DetaN Options selecfion sheet (huildings with 3 or less uniLS) Minnegasco mechanical ventilation form Date ~ / ~ q I n Construction Cost „ )n ( ~ Unit/Ste # ,R Site Address la ( 1 A 11 V ~ Description of Work l ~ Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2 Telephone#(~ 0(\ 1 ~IrJ~Jl Property Owner Contractor b ~ Address L n ILJ~ City State _ ~I V Zip Telephone # ((_Q~ tty-1( x G COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672 Energy Code Category , Residen6al VenGlation Category 1 Worksheet • New Energy Code Worksheet (J suhmission type) Submifted Submitted . Energy Envelope Calculations Submitfed In the last 12 mcr.ths, has the Ci}y of Eagan issued a permit for a similar plan based on a masier plan? Y _ N If yes, date and address of master plan: Telephone ~ Licensed Plumber Mechanical Contractor Telephone ~ Sewer/WaterContractor Telephone#( { I heeeby 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 Ciry 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 star[ 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 L ~r Applicant's Printed Nam~ e~ T- App cant's Signature 1 CityEapof 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink Permit#: Permit Fee: Date Received: /2 3! Qv Staff: 0 2009 RESIDENTIAL BUILDING PERMIT APPLICATION Date: bl/ti II/t Site Address: 17/ LW** 61'r , Tenant: Suite #: RESIDENT / OWNER Name: 270.4 i it z Address / City / Zip: 17/6 W044 4411- ebr40 Applicant is: Owner Contractor Phone: (CY—dib-od6K TYPE OF WORK Description of work: A 5. e Ike/flew"- Construction Cost: ti"tie7_®J®m Multi -Family Building: (Yes / No V ) CONTRACTOR Name: Vel E ;?96 Addressl.'"al "c, City: !I i -u -K5 v,74° State: /4Zip: 5-5-3 3 % License #: 07-4i?367 7 Phone: Q-4 1- W / (566/6 Contact Person: /1144 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes No If yes, date and address of master plan: Licensed Plumber: Phone: Phone: Sewer & Water Contractor: Phone: Mechanical Contractor: NOTE: Plans and supporting documents that you submit are considered to be public information. the information may be classified as non-public if you provide specific reasons that would perm► 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. x f ,4t./ I4a' Applicant's Printed Name x - Appli ant's Signature Page 1 of 3 øú þ ý þýý üûúû ú ùýýúñúîé ÷ äðß ÿ þý÷ üûúùø ÷ ô ô ÷ôùø ó ö ÷ ô ô ã ôüØ ã ôùø ã ûé ûô ü ô óû ú ò óû ú üØ ý ù ô ô ñûùò ð÷ê ûôë ýãó ô í æêäêðä öù üûô ô íè æê ê õøôø ÷óò øø ùÖøø ùã Ø ñûùò ð÷ ß÷ ûñô ûôë þ ãó Ý Üððð ô úù ö ë ô øø éô ôô ô øùö øø ú ü éã ü û ñùéþ ìô ê øø õ ô ü ûô û ùü ûô