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796 Wescott Square Wemficate of cccupanc~ c0tv of Cpagan This Certif cate issued pursuant to the nequinements of the Uniform Building Code certifying that at tke time of issuance this structure was in compliance with the various ordinnrtces of the City regulating building construction or use. For the following: SF DWG/GAR 22355 Usc Classification: Bidg. Pmrdt Na Oc-p-rType-FI~EFERAEff-~~sa„` 55434 Owocr of suilding Ad~ss 196 v • • woseevf Building Address I.ocaliry I / Buildmg OPEicial ~ PQST IN A CONSPICWUS PLACE ~ . INSPECTION RECORD CIT* OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: itif APPLICANT: PERMIT,$UBTYPE: TYPE OF WORK: iNSPECTION , . ;ii , 1:1 1,!1 . , , 11M 1 fJI; ,:,f t I I 1•I1+ 'I ~ ~i•,11) rs I 11tt1 I I 1, f 1'I 11~ : : i tl!•. ~ 1 f;, Y 1{'I,. I ~ ~ ~ : Permft No. Psrmit Holder Date Telephone # SlYV ` PLUMBING HVAC ~-4- /8' 9 O 9 ~U 5 ELECTR EIECTRIC Inspection Date Insp. CommeMs Footings 1 Foundation Framing d Roofing Roug, Ptbs. 334S/ 4' - Rough Ht9. lsul. ~ Freplece Z? ~ Flrial Htg. 3 ~ Orsat Test Final Plbg. Plbg. Inspeclor - Notify Plumber Const. Meter o GZar~rJ, dI dAWtgo, Engr./Plan ~ Bidg. Flnal 42 Dedc Fig. Deck Rnal Well Pr. Dfsp. '2c~ ~ Address 796 wescoxT sQunxE Zip 5512_ Lot io Blk Z Sub WEsCOTT SQUARE THESE ITEMS WERE! WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION. Date: y~ Yes No Inspector: Final grade (6" from siding) Permanent steps (garage) ? Permanent steps (main entry) Permanent driveway Permanent gas ? SodJSeeded grass ~ TraiUcurb damage Porch ~ Basement finish ~ Deck Please verify with the builder [he removal of roof test caps from the plumbing system and the shuaoff of water supply ro the outside lawn faucet before freeze potential exists. ContaM engineering division at 681-4645 before working in rightrof-way or installing underground sprinkler system. ~ - White - City Copy Yellow - Resident Copy Pink - Contractor Copy ~ CITY OF EAGAN PERMIT 3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G Eagan, Mi nnesota 55123 Permit Number: 022355 (612) 681-4675 Date Issued: 12/01/93 SITE ADDRESS: ~ 796 WESCOT7 SQUARE LOT: 10 BLOCK: 2 P.I.N.: 10-83730-100-02 WESC07T SQUARE DESCRIPTION: ~ Build3-ng, Permit Type SF DWG 9uilding-Wqrk Type NEW ,tlBG Oocupancy, Ft-3 M-1 , Construetion T~-pe VN / Zdnzng ~ R-3 / Building Length ~ 40 ,f Building Width 30 `iio/ _ ~ `Ji? . f _~.,i ~ r _ . REMARKS: FEESUMMARY: VALUATION $77,000 Base Fee $536.00 MISC FEES $1.744.50 Plan Review $346.40 7ota1 Fee $3,417.40 Surcharge $38.50 SAC $750.00 SAC % 100 SAC Units 1 Subtotal $1,672.90 `pRE•PCKxMBLDRS 17866000 0002555 PRE'PE'RRED BUILDERS 8741 CENTRAL AVE N 8741 CENTRAL AVE N BLAINE MN 55434 BLALNE MN 55434 (612) 786-6000 (612)786-6000 I hereby acknowledge that I have read this application and state that the information zs correct and agree to comply with all applicable State of Mn. Statutes and City of Eagan Ordinances. II ~f~~n ~,~~:r~. I ~ - APPLICAN7/PERMITEE SIGNA7URE ~ SI 6UED : SNATURE KLNLJ.4YMIG:~~ v~~ ~ v• ~r~w.~~• aEr~1T # OCT 2 1 1593 1893 BUILDING PERMtT APPLICATION 681-4675 ~3 - - SINGLE 6 MUL7I-FAMILY 2 sets of plans, 3 registered site surveys, i copy of energy calcs. COMMERCIAL 2 sets of architectural 5 structural plans, I set of specifications, 1 capy of energy calcs. Penalty applies: 1) 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 fs requested once permit is issued. Date 10/ 93 Yaluation of xork dr Site Address: ~~~ICF STREET SU1TE 1' enant Name: (commercial only) IAT O BIACK ~ S 0r • ~ P.I.D. 0 ~r Destri tion of w ' 3 The applicant is; ? Owner Contractor ? Other (o.s«ibe) Name Phone PrGperty L.sT rtasr Owner Address STpEEt STE M City State Zip Company e Ck.RP &NAOkS_ Phone 7g&- (~006 Contractor Address d tql C,t°0_1'~AL A/tf /V- License # zYS^S' Exp. city 61A41JG 5tate M - zip 5'5 Y3 Company (f~2 llUe- DesiA~1 phone 0 Architectf Eng(neer Name SrtOPi ~e~fl& Registration N Address ti ty 9GWS;1 i~le' state M' ztp _ Sewer & water licensed plumber C.t Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that 1 have read this application and state that the information is correct and a9ree to comply with a11 appllcable State of Minnesota 5tatutes and City of Eagan Ordinances. - _.",,re of Applicant: b`iG(L ~/I~ ~JLUS~Q~J OFFICE USE ONLY BUfLDING PERMIT TYPE ' • [3 OI Foundation ? Ob Duplex O 11 Apt./lodgtng E3 16 Basement Finish ~ 0 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Nisc. D 17 5wim Pool p 03 SF Addition 0 OB 8-Plex [3 13 6arage/Accessory O 18 Comm./Ind. O 04 SF Porch O 09 12-Plex E3 14 Fireplace [3 19 tomm./Ind. Misc. p 05 5F Misc. ? 10 Multi. Add'1. O 15 Deck E3 20 Public Facility O 21 Miscellaneous woRK nrPe d 31 New O 33 Alterations 0 35 Tenant Finish 0 37 Demolish O 32 Addltion ? 34 Repair E3.36 Move GENERAL INFORMATION Const. (Actual) v- N Basement sq. ft. MWCL System k2i A1lowable) v-nj lsi F1. aq. ft. City Mater Y:7~ UBL ~ccupancy Q-3 71 2nd fl. sq. ft. PRY Required Zoning 2-3 Sq. Ft. tota l Booster Pump / of 5tories Footprint Sq. ft. Fire Sprink ler length yc= On-site we11 Lensus Code /cr Depth 3~ On-site sewage SAC Code ~3 ! APPROVALS i Planning Building Assessments Engineering Variance REOUIRED INSPECTIONS E3 Site O Footing ? framing O Insulation ? Wallboard O Final ? Oraintile D fireplace Permit Fee wi~.cien; S --1]~, ~Oa Surcharge Plan Review License MWCC SAC Lity SAC Mater Conn. Water Meter Attt. Oeposit S/W Permit S/W Surcharge Treatment R. Road unit Park Ded. Trails Oed. Lopies Other Total: ' SAC % 10':~, SAC Units . . -'.r~ ' . ~ • " • EX?ERIOR ENVEIAPE AVERAGE "U" CON3UTATION IOWNER ~ SITE ADDR£55 Lc U~J;~a CONTRACTOR DATE PHONE DeLezmine vorking square footaqe of each. ~ 1. Total exposed vall area n sq. ft. x . 11 2Z-~i,?4 • 2. 1bta1 roof/ceiling area lp Gae: sa. ft. X, oZCo - y. ip) A. Total wall Window area ~411 8. Total door area C. Total sliding glass door area 3~ D. Total fireplace Wall area E. Total wall framing area (avezage 10i)........... ~'4'/~ F. Total Rim joist area............................ A13 G. Total Net wall area above floor................. • Total exposed foundation area - b` (v H. Total foundation window area ' 1. Total net foundation area above grade........... Detezmine "U" value of each aall segment. x ^v^ n. x^v^ 17 3 = tr ~ C. ~ X °(T. ~ ~"7 ~'J ° ?y' ~ • d. X 'U-. C. 1 U~' xoVm. • ° 2.~! ~7 d f. ~ x -u°9• X"U" .04 - 40~ O lI. X ^p" Q i1,2 x"v° .15 3....r ..............................TOta1 If item k3 is the sane as, or less than item M1, ycu have a,et the intent of SBC 6006(c)2. . ' . . . . . . . ' Total exposed zoof/ceiling area ~ Jta (PG j. Toial skylight area k, 1bta1 roof/ceiling framinq area (averaqe 101)...... 111-z- 1. Total net insulated roof/ceilinq area Determine "U" value foz each roof/ceilinq segment. ' x -n• 5~ - i• • ~ IC.tr~ X RUN 1. • g~~4 X"0• ~ GZZ ~ zo~ a[9 a ...............................:.....Toral If total of 04 is the same as, or less than $2, you have met the intent of SBC 6006(c)l. ' . Alternate Building Envelope Design Rb utilize the total envelope system method, the values established by the svm of items 03 and U4 shall not be greatez than the sum of items /1 and !2. ~ 1. + 2. ' . . 3. + 4. ~ . i 14,fx~Y4FE~~ s ~J+t y, ~ ti~F cR ~ x x ~ y t ? d ` 994 PLUMBING PERMIT (RESIDENTIAL) CTI1' OF EAGAN ~ 3830 PILOT KNOB Rb - EAGAN MN 55122, (612) 6814675 PLEASE COMPLETE FOR SINGLE BAMILY DWELLIIVGS -•ALSO, F0R=;T0~,;~N I ; OMES,A~,ND- CONDOS WHEN PERMTTS ARE REQUAtED FOR EACH UNTT.:; _ . NO. FIXTURES EACH ..TU7'rAL ~ SHOWER 100 WATER CLOSET BATH TUB 3.00 LAVATORY 300 _I KITCHEN SINK , 3..0.0 LAUNDRY TRAY 3.00 HOT TUB/SPA '3.00 ~ WATER HEATER 3.00 3a7~ lL FLOOR DRAIN 3400 GAS PIPING OUTLET ~ minimum - t 3.00 ~ • , ~ ROUGH OPENINGS ~ 1.50 WATER SOFTENER PRIVATE DISP'. • nek.cry. iic. 20.U0 ' U.G. SPRINKLER • nome unaer consi. 3:00 Q' " ALTERATIONS • w cdsiing 20.004 WATER TURN' AROUND 20.00 STATE SURCHARGE :SOy TOTAL: SITE AD;DRESS;_ OWNER NAME:_ IOfU INSTALLER; ADDRESS: ~oq D~I wi Y1. Yl~.~Q- CITY:_Id'!~KL~r2 1'au~ ST.ATE: ZI+P CO,(E.' lfafi vt~~ PHONE ( ~ fa~ 5.33 ' ~43 5 -7 &gin ki~_ Sl NATURE OF RET2MITTEE . . . . ~yY: J'. " _ 3 1~ ' t 1 . _ _ . . . ~ _ _ . . tyv~~ s ~y x c' #y,9'gri <SY` S 3 ~ ~k~i S ~ i q QY. ~yy~ty F q b H y: 4 . . 1994 PLUMBING PERMIT (COMMERCIAL). CITY OF EAGAN 3830 PILUT If]VOB RD EAGAN MN 55122 (612) 6814675 PLEASE GOMPLETE FOR ALL CQMMERCIAL/INDUSTR'IAL BUILDINGS: ALSO FOR IvfULTI FAMILY BUILDINGS WHEN SEPARA'PE PERMITS ARE NOT REQUIRED' FOR EACH . DWELLING UNTT. NEW CONSTRUCt'ION ADD ON . ' REPAIR WO:RK DESCRIPTIQN: CONTRACT PRICE: $ FEC: 1°k OF CONTRACT'ME. STATC Sl3RCHARGE: $.SO FOR EACH $1;000 OF FEE. fi1INI111UT4 FEE: $ 25.00 - COI\iTRACT PRICE X 1% $ , STATE SURCHARGE $ - , TOTAL $ SITE ADDRESS: ' TENAIVT NAME: ' $TE. # OWN°ER NAA4E: - INSTALLER: - ADDRESS: - - CITY: STAT'E: ZIP CODE:: PHONE " FO.R: CITY OF EAGAN APPLICANT ~ ~ k a.x~G s ay»y ~ e~Y~'~>` »i'`dv~ ~"3~•E,k~~ 3;~' ~ ~~a~~3.~ ~'~?'aw~m s~'3s,.~' "r~~~x~ az ~ y~ r ~fi~'.f g 3 ~ 03. . C a..aa~ ~sc c 3 3~ . s`' ~t ~ . . . . . w~~~..M. ' . n. . . . R r.:~MaO wwmm. ..CS a}.aa.eb2~»...~ '..wn i .:kbn n oun.... o ~<e.~. k. . . 1994 MECHANICAL PERMTI' (RESIDENTL4L) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 , (612) 6814675 PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUII2ED FOR EACH UNIT. 1/ NEW CONSTRUCTION P.TJI?-Ort PJC ADD-ON FURNACE FIREPLACE INSERT DATE FEES HVAC: 0-100 M BTU.----------- ~-:AI3HiTrONAL 50 M BTU -6:00 GA$ OUTLETS (MINIMUM 1 @ $3.00 EACH) '.3, ov ADD-ON/REMODEL (EXISTING CoNSTRUCTION) $ 20.00 STATE SURCHARGE .5 TOTAL ~ 17 ~S_v S1TE ADDRESS: ~ lN ~ C0 S Gt.l~ OWNER NAME:'11-2TerV'e-d TELEPHONE ~~P6 - b DOD INSTALLER: rnsvi e i, , • ADDRESS: 12481 Rhode Island Ave. So. CITY: 894-0005 STATE: ZIP CODE: TELEPHONE S TU OF PERMITTEE Us~ ~1 1 . ~s a~ .r$LhiT E§ '~a ~¢~ss x'?'$ Eex ~ CSi ivY~l~'.°, r<3° #"~k e ax~a '~`p i e r ~ ~ s s;s j~ ' K7VDb~< '+'~n°`a a c<S& .a.a c~aa.. 'u S S3~sL° y~.vF 2£ si 3 . , ....~.3~.a,.~ i,se 1 °sx°.~sx~zL.,.~~m Ya'~M:~'~~'~S,a",a.. a,c~.An~~`if~. ~na~_~ c.z>s"';ii.,~'.`~' x..., °a_o>€ :s .:ar • _ 1994 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 6814675 PLEASE COMPLETE FOR ALL COMMERCL4LlINDUSTRIAL BUILDINGS. ALSO COMPLETE FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. DA7'E: CON`IRACT YIZIC;r;: $ NEW BUILDING INTERIOR IMPROVEMENT WORK DESCRIPTION: FEES 1% OF CRT'RM FEg $ PROCESSED PIPING: $25.00 MINIMUM FEE: $25.00 STATE SURCHARGE $.50 FOR EACH $1,000 OF ~'ET2~I1't' FEE. TOTAL $ SITE ADDRESS: OWNER NAME: TELEPHONE TENANT NAME: (IMPROVEMEN75 ONLI) INSTALLER: ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE SIGNATURE OF PERMITTEE CITY INSPECTOR ~ ~ At}DRESS.: 796 Wescott 5 uare ~ q BENCHMA~2K: To Nut H` rant 5E Corner of' Lot 10 'Blc~ck 2 MA K P Yd . , Elevatio~ = 890.74 N _ _ - _ ~ , 8p0 ~3enates House Address o _ N Denotes Iron Monument ~ S'~~ ~ Ueriotes Wood t ke 9 ~ s. ^ s v~ 5 a ' y ~ '.o`~: . X 0 4 Q. 0 Den o t e s Exis tin E lev a ti o n n~ ` ' m g ~e ~ ( 000. 0) Deno~es Prc~posed` Elewation as e / .A . ~ E °E , ` Denotes Direction of Surface Draina e , 32 . . Jo ~ ~ . 9 e p° ~3 i y,0~ ~~U9 ~a$ ~ F _ = 0'2 p ~ o, _ ~6 ~ Proposed Top of Gara e laar E~.evati.on Lot 10 89 . 0 ~0 9. p~ ~ , 0.33 ~1 „ , pg i ~ -~ov~ . ~ ~ 1. = ~ ~ Pro osed Lowest Floor Elevation = Lot 10 = 885.5 3 o~ p ~ 0~ o ~ o it ~ 8gy' ~ ~h~~ ~V - ' f,l ~ i ( ' 1l o y U , I ~ ~ ~ B a~ ~ i ~ ~ ~ ~ _ , ~s, i ~ , dti ~ , / , e ~ i Noa . w~1 ~ ,n CI' 5.;3 ~ j0~ a~ A o M I hereby certify that this is a true and correct representation of ,.2 ~ ~v G ~ 9 ~ I ti ,s1'~ to' M oN survey of the boundaries of: ntation of a 6y~ ~ ti ~ . o R~ 6~8, v~ i9•6 ~ 6 ~ ~ •S w ° 61 .~0 Lots 10, B1ock 2, WESCOTT SQUARE, Dakota Ca~nty, Minnesota., ~ s~ ~g89~ o , ta. ~ v~ ~ 4 3'' ~.1~ Z o And of the location of all buildin s, if any, therean, and al1 visi] o ,s3` ~ t al1 visible ° ~ ° ~ a$ encroaehments,, if any, from or on said land. It also shows the location e location of ~ ~ 13~1 ; the stakes as set-for a ro osed buildin . As surve ed b me or under , ~ ,''yJ g1o ~ P P 9 Y , Y - ~ 5 ~332 'r su ervisic~ti this 12th da af Octbber 1993. ~ or under`my ~ 9gso S~0 ~ d~. ect p Y , 0 z, w< o,•.' % ~ .2p .22A : ~ ~ , ~ ~ ol Q t~~~ y- o ~$gB~ ; f~'l~~OMBS FRANK ROOS ASSOCIATES, iNC. ` ~ Jo FES, iNC. . ~ x . ~ / '0 3~~ ~ - .j,f~ o f p , . N vt~ . E ,h~ . ~ ~ ~ y G ~ , aa .r - rG' ~n~ ~g Z p e ~ ~ , ~ 5 0 Patz~ A. John n ~ \ e a ; 11, _ ; N p , Land ~urveyor, Minn. Reg. No. 10938 Ko. 10938- a g. I a ~ ; ~ ~o ~i ' o ~13~3z o 1 S~~ ° ~ N ` . ~ 8~2~ 15 ~ - 5~ , ~ V~ 6 - ~ ° oi33z ~ _ , ~ ~ ~ ~51 ' ~ ~ ' ~ lo' ol S ~ o'~~ ag' ~ ~ _ qh ,~'b ~ ~6 ~ r M• 4 , ~ _ Sn a ~ ti ~o o ~ ; - I` ~ Z ~ , ~ L~ _ _ ' N -o-/o' 4. - Op, Q . 0 2 33 6' - 25 ~ . ~ _ _ . o ~ ~ J ~ - - I ~ ADDRES • 0 e u re ~ r.. 0~ S. $ 2& 80¢WscottSqa , vo ~ •o ~ ~ 3 BENCHMARK: Top Nut Hydrant SE Corner of Lot 10, Block 2 Ele xk 2 Elev = 890.74 • ~ ~ A~'~~ ~ J ~ • °p ~ ~ t0 Q , _ 0, 800 Denotes House Address \ o ' 796 I 'h ~ 0 N 0 Denotes Iron Monument 9 ° ~ n ~ ~ o \ ~ PROPOSED ~ 0, a ? Denotes Wood Stake 1 °o r ~ ~ I z" ~ BwGDiNG 2' ~ ~ X000.0 .Denotes Existing Elevation ~ ti a ~ ~ o , (000.0) Denates Proposed Elevation ~ 0 .o A ~ .C ~ L N m• ~ 0 ' -E Denotes Direction of Surface Drainage ~ b b m ~ Q . \ ~ l6.69 0, Q ~ 3 33 25~ Proposed Top of Foundation Elevation = Lot 13 = 889.80 ~ - - ~ - 30 a , I Lo~ 24 - sag.ao ~ Q 30 ~ ~ ~ 1 I ,o~ ~ ' aa9 Proposed Lowest Floor Elevation = Lot 93 = 865.6 ~ a , l ~ ~ o 0 0~ N; ~ot 14 = 885.6 . 6 6 n M'~/ m J , ~ I ~ ~ ' - - - ~ ~ . . 3 'o , I hereby certify that this is a true and correct representstion o ~ J ~ I °1 asentatiQn oP a survey of ~ ~6~,~6 the boundaries of: _ 24.3¢ 30.33 /5 `p~•o~~ kh ~ Lots 13 and 1~¢ Block 2 WE5COTT SQUARE Aakota Count Minne N89 36 !4 W 69. 67 ~ , , Y~ ~ 3unty. Minnesota And af the loeation of alI buildings, if any, thereon, and all vi; , and all visible encroachments, if any, from or on said land. It also shows the l~ shows the location of the ' stakes as set for a proposed building. As surveyed by me or unde: y me or under my direct supervision this lbth day of Jul : 1993. - Y~ ~ McCOMBS FRANK ROOS ASSOCIA' IOOS A$SOCIATES, INC. Paul A. John . Land Surveyor, Minn. Reg. ] , Minn. Reg. No. 10938 , N DESIGNED CHECKED I HEREBY CERTIPY THAT THIS PLAN WAS PREPARED BY ME OR ' $CALE SHEET REV. ~ UNDEA MY DIRECTSUPERVISION.ANO THAT I AM A DULY REGISTEH- ~c_ ~ PREPAREO FOR ~ ; McCombs Frank Roos Associates, Inc. ~ 20 Z. ED PROFESSIONAL ENGINEER UNOER THE LAWS OF THE STATE OF DRAWN APPROVED MINNESOTA. BOOK PAGE A ~ A ID•!? 93 tANI d dde d L o f/0 15050 23rd Ave. N. En in ers g TAM 9 e ~ Plymouth, MN 55447 Planners D z N0. DATE BY REMARKS ~ M FILE N0. p DATE 0 M. E . 6,2~47s-s0, FE r 0 Su~ve ors ~ o Y REVisioNS 7- ~6 -93 DATE REG, N0, ~QI~J'~ 9 ' ~ E R S I~~. OF ~ _ RESIDENT OWNER Name: Phone: Address City Zip: Applicant is: Owner Contractor TYPE OF WORK Description of work: ii)-A-c3 f sr .1.. R 6:- 00 Ce Construction Cost: Multi Family Building: (Yes No 7� 77�� CONTRACTOR Name: P- G tr SSA/` flop4 License L 7't Address: /77(.) J q F jI 0 City: 60cc4,9 (4v State: )2 Zip: 5 02-7 Phone: gas f ''QQ>' 2 )"Contact Person: edt 1 C COMPLETE In the last 12 months, has Yes No If yes, THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING the City of Eagan issued a permit for a similar plan based on a master plan? date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be publ i nformat i on. Port 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. City of Ea�an Tenant: 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 r For Office U 2009 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: 6 fr I 5 au 4 f x (C., j &L) v -'(C:-c 5t:)A/ Applicant's Printed Name Use BLUE or BLACK Ink Permit Permit Fee: Date Received: Staff: Suite CALL BEFORE YOU DIG. Call Gopher State One CaII 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.orct 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 Applicant's Signature Page 1 of 3