846 Ivy LaneOily of EaQali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
/0o0 87.5
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Received:
Staff:
J
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: s/z.J Site Address: O o 16 I V Y LAME
Tenant: Suite #:
RESIDENT / OWNER
Nam& ,4 r M 4#J4 6/4Ev7 Phone: 76 3.593- 9770
Address / City / Zip: 850 L7EC.Ei T R, AVE ! 442A- &01..DEN YAUM 551427
Applicant is: Owner X Contractor
TYPE OF WORK
Description of work: !EMOVE AND £EPlAC..E goof
Construction Cost: 920o. Multi -Family Building: (Yes / No
)
CONTRACTOR
Name: 8E1 EXTEg. LOX humin. • ca1R.P. License #: 202 1/1/31
Address: Co. 60 g%'�'r City: /ill /V/VE`� FGG.4$
`1/0 /5
State: J14 Zip: 6-51114? Phone: 6ii 24 /" 4a 2 T3
Contact: pAU.L. Email: 1rr' 7 be 1 Lm • COM
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:
inf at on ° Poi/ (ons o
e %forma m a g W _. t would permitt erCity t
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.aopherstateonecall.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 work which requires a review and approval of plans.
x ate, cisiC Jro
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 2
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675-5675
www.ci.eagan.mn.us
PERMIT
City of En
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Plumbing
EA087697
12/08/2008
ePermit
Site Address: 846 Ivy Lane
Lot: 8 Block: 02 Addition: The Woodlands North 3rd
PID:10-75892-080-02
Use:
Description:
Sub Type:
Work Type:
Description:
e - Water Heater
Replace
Water Heater
Meter Size Meter Type
Manufacturer
Serial Number Remote Number
Line Size
Comments:
Stephanie Johnson
2200 W. Hwy 13
Bumsville, MN 55337
Fee Summary:
PL - Permit Fee (WS &/or WH)
Surcharge -Fixed
$50.00 0801.4087
$0.50 9001.2195
Total:
$50.50
Contractor:
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
- Applicant -
Owner:
Robert N Katz
846 Ivy Lane
Eagan MN 55123
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
Applicant/Permitee: Signature
Issued By: Signature
411,11/
City of Eau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: ;2.
r
Use BLUE or BLACK Ink
For Office Use
(�
Permit #:
Permit Fee:
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
2 4- Site Address: 9 3/Z 1T /� ✓` 4 J'-7 Unit #:
esid
y ' Q
> � Y�'
Name: J - Phone: 1767 i p %/
Address / City / Zip: /Y1.../ /-40---77 ei
Applicant is: Owner Contractor
of u
T of or
Description of work: � � 1��. �� � 'fi�
p �/ 14, .r, c �i )1:1---/-17Z,/961
if j/ ,..,%�
Construction Cost: 0/0)W` Multi -Family Building: (Yes / No )' ) '/ di
Y �v
Ctra
Company: //'/� / 7 ! s : sC 1 / Contact: r_./.., %.7�`
Address: / Z. l A4�f �lr dy ity� a/j
State:/ -0 Zip:517,5-3t.7 Phone:/i7;(' i'7,„,'z Email:
N
License #: �; (1 „�7YPf:` 3 Lead Certificate #:
If the project is exempt from lead certification, please explain why: ./%
In the last 12 months,
Yes No
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?
If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
Phone:
! $ /�:� to �Y a e
TIE �' s � `ortr documents> that ou it ire' °info =eta # n
tion Y e c si'fis ubio vrdc ` dsoOl!l a
Sit s.
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 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.
x 2V 12 (Ph J2 { /Y3
Applicant's Printed Name
,--).e-e-lam. `? 2 '' "
Applicant's Signature
Page 1 of 3