1616 Clemson Dr B CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road PERMIT NO.:
P.O. Box 21199
Eagan, MN 35121 No. of Units:
Zoning:
Owner: - --
Address:
Site Addess:
Plumber: Connection Charge:
Meter No.: Account Deposit:
Size: r N
Reader No .: Permit Fee:
m i agree to comply with the City of Eagan Surcharge:
Misc. Charges:
Ordinances. Total:
Date Paid:
Date of Ins - P.: y r Insp.:
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CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road PERMIT NO.:
P.O. Box $1 199 DATE:
Eagan, MN 55121 No of Units:
Zoning: _
Owner:
Address:
Site Address:
Plumber:
1 agree to comply with the City of Eagan Connection Charge:
Account Deposit:
Ordinances. Permit Fee:
Surcharge:
Misc. Charges:..
By Total: Date of Insp.: Date Paid:
Insp.:
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Use BLUE or BLACK Ink
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For Office Use
Permit
r City of Ea~~ii a~
~ Permit Fee: ~
3830 Pilot Knob Road I ((3 1
Eagan MN 55122 l Date Received:
Phone: (651) 675-5675 1 I
Fax: (651) 675-5694 1 Staff: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: adl~l Site Address: M 9QK, 6 Unit
-
Name: l ~/ttl5 t!f l AO/h~ S ( -GJ r L2 Phone: 7q 7 7 511
t Resident/
Owner Address / City / Zip: #C3z),re
I Applicant is: Owner Contractor
Type of Work Description of work: 14Y 'F- r e D'
Construction _Cost JUlulti F
Company: ~ Contact:
q3q: {~G_ 6n in ,e. N ► ~1 L alto
Contractor i Address: City:
i State: Zip: Phone:*
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ea~ eCerti ief'W.- _
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
(lV o Af)ZA, bet-'o 0
i 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:
I 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 Cali at (651) 454-0002 for protection against underground utility damage. Cali 48 hours
before you intend to dig to receive locates of underground utilities. www.gooherstateonecall.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 tate Building Code must be completed within 180
days of permit issuance.
X t)(1~i V'VIe-S- x
Applicant's Printed Name Ap 'cant's Signature
Page 1 of 3
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PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA140598
Date Issued:01/05/2017
Permit Category:ePermit
Site Address: 1616 Clemson Dr B
Lot:10 Block: 01 Addition: The Trails Of Thomas Lake
PID:10-75865-01-100
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 -
Linda M Bosma
1616 Clemson Dr B
Eagan MN 55122
(651) 330-2488
Wenzel Heating & Air Conditioning
4145 Old Sibley Memorial Hwy
Eagan MN 55122
(651) 894-9898
Applicant/Permitee: Signature Issued By: Signature