1341 Easter LaneRESIDENT /OWNER
-- G r d - ''GS, /? t
Name: 4 _ A / 4,r-fe .) J es-1 Phone: -
,C
Address / City / Zip: / J�'/l eG , s t . f L c n) �L S.J G1-. J ,
Applicant is: Owner '' Contractor
TYPE OF WORK
Description of work: / C o a
Construction Cost: 4 6);20 ^ Multi - Family Building: (Yes / No )
CONTRACTOR
Name: G' Cie," /< ,r ,L,i, 17., c. 1 _7:7,J(.... License #: c) c c/
J
Address: t O_ iC3® K y City: 4 y ,',) f v - / c A
State: 4 Zip: ,S 5T33 ) Phone: c r� - `/..r— 75` cf
Contact: (9 e_,,,.1 Ce le. z.J Email:
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:
NO TE: Plans and supporting documents that you submit are considered to be public information Port o f
ay be classified as on public if you provide specific reaso ns that w oul d pe rmit th Ci ty y to
t information m n
. conclude that t hey are trade ,' secrets.
4 City of Eaali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
x
Applicant's Printed Name
Applicant's Signature
Permit #:
Permit Fee:
Date Received:
Staff:
Use BLUE or BLACK Ink
9 55(0 to
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: S (D Site Address: / � �� — 73 ci / CQ ,r ,.,)
Tenant: Suite #:
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.
Page 1 of 2
City of Eagan
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Ll 1 16 Site Address: G
X C I r
Applicants Printed Name
Date Received:
Staff:
Use BLUE or BLACK Ink
.; s
Permit #: q C/ 5 -
Permit Fee: /3.4 I
Suite #:
RESIDENT / OWNER
TYPE OF WORK
CONTRACTOR
Name: P1..t . S A-1/4--Aet.c - -P li so Phone: (,) 2-
Address / City / Zip: 1ol3 A t7 / /14 » S o 7
Applicant is: Owner Contractor
Description of work:
Construction Cost:
0 6 O Multi- Family Building: (Yes / No 1
Name: License #:
Address: City:
State: Zip: Phone:
Contact: Email:
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:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information.
e .information maybe classified as non- public if you provide specific reasons that would parrs*
conclude that they are trade secrets:
Portions' of
the City to''
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_st- ■ 'thout a permit; that the work will be in
accordance with the appr ved plan in the case of work which requires a review and approv, ■ .lans
Applicants Signature
Page 1 of 2
1 3y I Eers�- Lin
RESIDENTIAL FEE
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S &W Permit & Surcharge
Treatment Plant
Copies
TOTAL
DO NOT WRITE BELOW THIS LINE
SUB TYPES
_ Foundation Fireplace — Porch (3- Season) _ Storm Damage
Single Family Garage
— Porch (4- Season) _ Exterior Alteration (Single Family)
Multi Deck _ Porch (Screen /Gazebo /Pergola) _ Exterior Alteration (Multi)
of 2 Plex _Lower Level • _ Pool _ Miscellaneous
Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
_ Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation AGM Occupancy 4C - MCES System
Plan Review Code Edition ,Zce/? SAC Units
(25 %_ 100% d) Zoning 12.• City Water
Census Code <1.341 Stories ---- Booster Pump
# of Units / Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Sheetrock
Footings (Deck) Final / C.O. Required
Footings (Addition) Final 1 No C.O. Required
Foundation HVAC
Drain Tile Other:
Roof: _Ice & Water _Final Pool: _Footings Air /Gas Tests _Final
Framing Siding: _Stucco Lath _Stone Lath _Brick
Fireplace: _Rough In _Air Test _Final 4 Windows
Insulation Retaining Wall: _ Footings Backfill _ Final
Meter Size: Radon Control
Erosion Control
Reviewed By: , ' / , Building Inspector
7 3
75
Page 2 of 3
VILLAGE, OF EAGAN WATER SERVICE PERMIT
3795, Pilot Knob Road PERMIT NO.:
Eo an, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.• Permit Fee:
I agree to comply with the Village of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By �,� / Date Paid:
Date of Insp.: @�1i NSPMO- sp.:
VILLAGE'OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Rood PERMIT NO.:
Eagan, MN 55122
Zoning: DATE:
No. of Units:
Owner:
Address:
Site Address:
Plumber:
1 agree to comply with the Village of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By: Misc. Charges:
Date of Ins .. s" • tal:
Insp.: .111iMa! Date Paid: