3771 Grey Dove LaneC!tyofEaaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
OW OS
961741
Permit Fee: JP` CO
Permit #:
Date Received:
Staff:
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ___9___ / V Site Address: 3771 __ ie L/V
Tenant C
-J
Suite #:
RESIDENT / OWNER
Name: Phone:
Address/City/Zip: 3271 l? n UU Lill
Applicant is: Owner Contractor
__
TYPE OF WORK
Description of work:
Construction Cost: rte- Multi -Family Building: (Yes / No')
CONTRACTOR
Name: ±S. t44 % C' License #: _: Q c>4 t,g-
_
)' (
Address:.—_1�
V22\� I iris_ City: -` kil 4 fif,
F-�
State: i Zip: V 0 G Phone:
. "
__ _VI.,s.
J Email: ��V 1-��-�- 6m)-1.. LCOn ,
Contac t: -
_
COMPLETE
In the last 12 months, has
__Yes _No If yes,
Licensed Plumber:
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:
Phone:
Mechanical Contractor:
Sewer & Water Contractor
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public inform ; Portfons of
the information may be classified as nonpublic if you provide specific reasons that would permit tI CFty to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Cali 81(651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.goaherstateonecall.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
Applics Signature
Page 1 of 2
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 3771 Grey Dove Lane
Lot: 2 Block: 19 Addition: Town View 1st
PID:10- 77100 - 020 -19
Use:
Description:
Sub Type:
Work Type:
Description:
Comments:
Fee Summary:
Contractor:
Wenzel Plumbing & Heating
1710 Alexander Rd
Eagan MN 55121
(651) 452 -1565
e - Furnace
Replacement
Furnace SEE COMMENTS
Quesetions regarding elec
952- 445 -2840
Jenny Hanson
1710 Alexander Road
Applicant/Permitee: Signature
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
PERMIT
City of Eaan
cal permit r equirements should be directed to Mark Anderson, State Elec
- Applicant -
Owner:
Christyna H Jarosh
3771 Grey Dove Lane
Eagan MN 55122
$50.50
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$50.00 0801.4088
$0.50 9001.2195
Issued By: Signature
Mechanical
EA078845
07/17/2007
ePermit
cal Inspector,
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
411/11 C!ty o[Bap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Received:
Staff:
0707 z-
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 9/24'12 Site Address: 3771 Grey Dove Lane
Unit #:
RESIDENT /
OWNER
Name: Christyna Jarosh Phone: 651 688-0737
Address / City / ZiP= 3771 Grey Dove Lane
Applicant is: Owner x Contractor
TYPE OF WORK
Description of work: remove and replace (8) winodws in existing openings
Construction Cost: 6000.00 Multi -Family Building: (Yes / No )
CONTRACTOR
Company: Builders and Remodelers Contact: Mary Anderson
Address: 3517 Hennepin Avenue South+ City: Minnepolis
State: MN Zip: 55408
Phone: 612 827-5481
License #: BC1100 Lead Certificate #: NAT -20683-0
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_Yes If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
_No
Licensed Plumber:
Mechanical Contractor:
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.goi herstateonecall.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.
Mary T Anderson
Applicants Printed Name
7. 1�
,
Applic nt s gnatu
Page 1 of 3
3~ c~~ 3~~ ► , 3~~ 3 , 3~ ? 3 t 3~ Ss G" Wive- L,aA
Use BLUE or BLACK Ink
1----
I For Office Use 1
I
Permit#: VO 3b2
City of Ea I Permit Fee: I
1
3830 Pilot Knob Road I t
Eagan MN 55122 i Date Received: 'D 2p I
Phone: (651) 675-5675 I
Fax: (651) 675-5694 ! Staff
# 9 L - - - - - - - - - -
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
E r c%, C)OVt CJm`^AJ
Date: w '1- l3 Site Address: 37i~7 3 71 , 3>73y 3777 7 21 Unit
Name: Phone:
r
s Resident/
( Owner Address f City / Zip'
Applicant is: Owner Contractor
I
Description of work
Type of Work
1 r
Construction Cost! J oLU+O p Multi-Family Building: (Yes f No
.,.....~..w... _ Company: Conte
I I nnt- tsnlC a.
{Address: e-cL, r , City:
Contractor
State: (y),AJ Zip: _-)'5343 Phone: 1 52 3-/ ~2 - 220-0
License # 4~ ; ~y `1 Lead Certificate ~OooC
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 pen-nit 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. Portions of
the information maybe 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.
I hereby acknowledge that this information is complete and accurate that the worse 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.
Applicant's Printed Name Applicant's Signature
Page 1r of 3