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4581 Horizon CirCity of Eaau 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 2010 RESIDENTIAL BUILDING PERMIT APPLICATION //68/ 74gizzy.4 Date: L/11/A) � Site Address: Tenant: e-A4 / 5 km I hereby acknowledge that this information is complete and accurate; that the work will be in conformanc Eagan; that I understand this is not a permit, but only an application for a permit, and work is not accordance with the approved plan in the case of work which requires a review and approve. Use BLUE or BLACK Ink Permit #: Permit Fee: Date Received: Staff: RESIDENT / OWNER TYPE OF WORK CONTRACTOR Name: ! °j S / Phone: Address / City / Zip: `J ( e n gl ?_ Applicant is: Owner "Contractor Description of work: - -60 Construction Cost: Multi- Family Building: (Yes,/ No ) Name: L 1 5e4fll v/ t7bnSti„ License #: Address: /7D- Aifji etAff. City: fr 1C°, // �6 V Phone: �l /Z' X70 O State: r /!r' /V Zip: � 7 � 7 Contact: (C 7 — 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. Pl ans and supporting documents that you submit are considered to be public information. Portions of the information m ay be classified as non -public if you provide specific reasons that would permit the C ity conc/ud they are trade secrets. 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 Applicants Printed Nam ants Signature �-- th the ordinances a codes of the City of art without a permit at the work will be in Page 1 of 2 o n . irra WATER SERVICE PERMIT o1 , Kamm Rood PERMIT NO.: * 857.E ` DATE: Zoning. r No. of Units: f Owne i, 3, ..: a= y e t }f. ( s address: Site Address: 3 :c r _r zo :. C r c l c L 1; 10 e s '.ter 1_. V Wumber ',. 1: ,_.<; x.c (:.. ric' san PLS.'; Meter No.: Deposit: C D Size: Account onnection C harge ` >,u ep : ).r i ni Permit:. I r r - 0. Reader No.: �ti fi . r n . el agree to comply with the City of Eagan Surcharge: 5 Ordinances. Misc. Charges: `7` ...r1 e ',:r ' Total: Dote Paid: Date of Insp.: / Z 3 — $ / Insp.: - CITY EAGAN ' SEWER PERMIT ., 3795 Not Knob Re PERMIT NO.- 5029 Eqggis, MN 55122 DATE: 12121/81 Zoning: RIV No. of Units: lk duplex o wner; Joseph M ller Construction t Address: Site Addritiff 458 o Cir L174131OP Mar East TV pl um b er: Marty's 1 (Erickson P4.bg) 12/21/81 284 2 100.00 pd 1 agree to comply wilIb iltit c Eagan Co iol 425_ 00 pd Ordinances. ccott%eposit: \ 1,... Permi Fee: 1,0_ 00 pd ) 4 °Surcharge: .50 pd By ( 4/ . .,29--- - , Misc. Charges: Dote of nsp • Total: Insp.: / Z2 5— 7/ Date Paid: I , PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA133030 Date Issued:09/18/2015 Permit Category:ePermit Site Address: 4581 Horizon Cir Lot:17 Block: 01 Addition: Ches Mar East 4th PID:10-17153-01-170 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: 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. Contractor:Owner:- Applicant - Charles Remy Iii 4581 Horizon Cir Eagan MN 55123 Applicant/Permitee: Signature Issued By: Signature